Organization
MARIPOSA COMMUNITY HEALTH CENTER, INC
Active
Organization
MARIPOSA COMMUNITY HEALTH CENTER, INC
Active
Other names
Mariposa Tubac Regional Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
AMY TAYLOR (CHIEF EXECUTIVE OFFICER)
(520) 761-2128
Entity
Organization
Contact information
Practice address
2221 E FRONTAGE RD STE 101, BLDG G-STE 101/BLDG F-STE 104, TUBAC, AZ 85646-9997
(520) 281-1550
(520) 281-4487
Mailing address
825 N GRAND AVE STE 100, NOGALES, AZ 85621-2385
(520) 761-2128
(520) 281-1112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
43414
AZ
207Q00000X
Family Medicine Physician
AP4918
AZ
207R00000X
Internal Medicine Physician
16163
AZ
207VG0400X
Gynecology Physician
43414
AZ
207VG0400X
Gynecology Physician
AP4918
AZ
208000000X
Pediatrics Physician
43414
AZ
208000000X
Pediatrics Physician
AP4918
AZ
208D00000X
General Practice Physician
43414
AZ
208D00000X
General Practice Physician
AP4918
AZ
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
AP4918
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156624
—
AZ
01
—
ZFQ31812
MEDICARE PART B GROUP#
AZ
Enumeration date
02/16/2016
Last updated
02/17/2025
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