1730310046 NPI number — GREENLEE COUNTY

Table of content: (NPI 1922294289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730310046 NPI number — GREENLEE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENLEE COUNTY
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:
GREENLEE HEALTH AND COUNTY SERVICES
Provider Other Organization Name Type Code:
5
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:
1730310046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
253 5TH STREET
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85533-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-865-2601
Provider Business Mailing Address Fax Number:
928-865-1929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
253 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85533-0936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-865-2601
Provider Business Practice Location Address Fax Number:
928-865-1929
Provider Enumeration Date:
08/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DEPUTY DIRECTOR HEALTH AND COUNTY
Authorized Official Telephone Number:
928-865-2601

Provider Taxonomy Codes

  • Taxonomy code: 261QA0005X , with the licence number:  OTC0267 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP0905X , with the licence number: OTC0267 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2400X , with the licence number: OTC0267 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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