Provider Demographics
NPI:1699173245
Name:TERROS, INC.
Entity type:Organization
Organization Name:TERROS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN HOFFMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-685-6000
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:6151-6153 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4598
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:623-937-2589
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERROS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-15
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAL000166261QF0400X
AZOTC-5659261QM0801X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ011432Medicaid
AZ011432Medicaid