1225023179 NPI number — GILA RIVER HEALTH CARE CORPORATION

Table of content: (NPI 1225023179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225023179 NPI number — GILA RIVER HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILA RIVER HEALTH CARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HU HU KAM MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225023179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACATON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85147-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-528-1200
Provider Business Mailing Address Fax Number:
602-528-1255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 W. SEED FARM RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACATON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85147-0038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-528-1200
Provider Business Practice Location Address Fax Number:
602-528-1255
Provider Enumeration Date:
09/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEMBERLING
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-528-1427

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  N/A , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 334582 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".