CARONDELET MEDICAL GROUP, INC (NPI# 1215974951) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215974951 |
| Entity Type | Organization |
| Organization Name | CARONDELET MEDICAL GROUP, INC |
| Practice Address |
1209 W. Target Range Rd. Nogales AZ 85621 |
| Mailing Address |
2202 N. Forbes Blvd. Tucson AZ 85745 |
| Practice Telephone | 5202874747 |
| Practice Fax Number | 5202853135 |
| Mailing Telephone | 5208727536 |
| Mailing Fax Number | 5208727929 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-02-22 |
| Authorized Official Name | MS. DEB S MOHESKY (EVP/CFO) |
| Authorized Official Telephone | 5208727745 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
Podiatric Medicine & Surgery Service Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659326585 | Carondelet Medical Group, Inc | Internal Medicine | 2202 N. Forbes Blvd, Tucson, AZ 85745-1412 | 2006-05-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CARONDELET MEDICAL GROUP, INC. | 3501 E Speedway Blvd Ste 300, Tucson, AZ 85716-3928 |
| Street Address |
1209 W. TARGET RANGE RD. |
| City | NOGALES |
| State | AZ |
| Zip Code | 85621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771033 | Intermountain Health Center, Inc. | Community/Behavioral Health | 272 West Viewpoint Drive, Nogales, AZ 85621 | 2017-10-24 |
| 1336696657 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 276 West View Point Drive, Nogales, AZ 85621 | 2016-09-02 |
| 1831584291 | Helping Ourselves Pursue Enrichment, Inc. | Community/Behavioral Health | 1857 N Mastick Way, Nogales, AZ 85621 | 2015-04-02 |
| 1043504376 | Community Intervention Associates | Community/Behavioral Health | 32 Blvd Del Rey David, Nogales, AZ 85621 | 2011-06-03 |
| 1568782175 | Arizona's Children Association | Clinic/Center | 1740 N. Mastick Way, Suite D, Nogales, AZ 85621 | 2010-06-04 |
| 1811032493 | Susan M. Jaworski | Local Education Agency (LEA) | 315 Plum Street, Nogales, AZ 85621 | 2007-02-21 |
| 1194885905 | Alex Gracia | Pharmacy Technician | 839 W. Calle Chico, Nogales, AZ 85621 | 2006-12-11 |
| 1982716130 | Yvette Denise Braun | Chiropractor | 1821 N Mastick Way #1, Nogales, AZ 85621 | 2006-08-31 |
| 1043254154 | John Diaz | Emergency Medicine | 1171 W Target Range Road, Carondelet Holy Cross Hospital, Nogales, AZ 85621 | 2006-06-16 |
| 1467495085 | Bart L Mc Rae | Emergency Medicine | Carondelet Holy Cross Hospital, 1171 W. Target Range Road, Nogales, AZ 85621 | 2006-06-13 |
| Find all providers in zip 85621 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053393298 | Valerie A Wohl | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2005-11-15 |
| 1285626754 | William Lester Bartholomew | Family Medicine | 1171 W Target Range Rd, Nogales, AZ 85621-2415 | 2005-08-19 |
| 1013523539 | Mariposa Community Health Center | Family Medicine | 1209 W Target Range Rd, Nogales, AZ 85621-2466 | 2020-09-21 |
| 1487041216 | Mary Carmen Garcia-kumirov | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621 | 2015-04-20 |
| 1922418979 | Jared Ryan Lunkenheimer | Family Medicine | 1209 W Target Range Rd, Nogales, AZ 85621-2466 | 2014-04-29 |
| 1275893729 | Rosa Isela Machado | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2012-05-17 |
| 1801123948 | Jeffrey Lynn Courville | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2009-11-10 |
| 1659468650 | Margie M Hartfield | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2006-10-10 |
| 1023035524 | James Lyle Derickson | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621 | 2006-07-17 |
| 1811930423 | Jeffrey Thomas Maudlin | Family Medicine | 1209 W Target Range Rd, Nogales, AZ 85621-2466 | 2006-06-13 |
| Find all providers in NOGALES | ||||
Please comment or provide details below to improve the information on CARONDELET MEDICAL GROUP, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.