| Svic | |
|
2273 E Wilcox Dr Sierra Vista AZ 85635-2755 | |
| (520) 226-9002 | |
| (520) 459-0563 |
| Full Name | Svic |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2273 E Wilcox Dr, Sierra Vista, Arizona |
| Authorized Official Name and Position | Rose Mary Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Svic Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Svic 2273 E Wilcox Dr Sierra Vista AZ 85635-2755 Ph: (520) 226-9002 |
| NPI Number | 1376065342 |
|---|---|
| Provider Enumeration Date | 07/12/2017 |
| Last Update Date | 04/20/2020 |
| Certification Date | 04/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376065342 | NPI | - | NPPES |
| 325286 | Medicaid | AZ | |
| OTC8548 | Other | AZ | BUREAU OF MEDICAL FACLITIES LICENSING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | OTC8548 (Arizona) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
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