Provider Demographics
NPI:1972891349
Name:SAN LUIS WALK-IN CLINIC, INC.
Entity type:Organization
Organization Name:SAN LUIS WALK-IN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:928-315-7910
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-315-7910
Mailing Address - Fax:928-722-6113
Practice Address - Street 1:214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-6329
Practice Address - Country:US
Practice Address - Phone:928-627-1120
Practice Address - Fax:928-722-6113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN LUIS WALK-IN CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ943699Medicaid
AZOTC3969OtherADHS LICENSE