Provider Demographics
NPI:1316999790
Name:UNITED COMMUNITY HEALTH CENTER - MARIA AUXILIADORA, INC.
Entity type:Organization
Organization Name:UNITED COMMUNITY HEALTH CENTER - MARIA AUXILIADORA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-407-5602
Mailing Address - Street 1:1260 S CAMPBELL AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0503
Mailing Address - Country:US
Mailing Address - Phone:520-407-5606
Mailing Address - Fax:520-625-8504
Practice Address - Street 1:15921 W AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735
Practice Address - Country:US
Practice Address - Phone:520-407-5606
Practice Address - Fax:520-822-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-02-20
Deactivation Date:2007-01-04
Deactivation Code:
Reactivation Date:2008-06-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031803Medicare Oscar/Certification
AZZ84080Medicare PIN
AZZ84080Medicare PIN