1134382211 NPI number — TUBA CITY REGIONAL HEALTH CARE CORPORATION

Table of content: (NPI 1134382211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134382211 NPI number — TUBA CITY REGIONAL HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUBA CITY REGIONAL 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:
Provider Other Organization Name Type Code:
6
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:
1134382211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUBA CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86045-0600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-283-2501
Provider Business Mailing Address Fax Number:
928-283-2677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 89 NORTH AT THE 466 MILE MARKER
Provider Second Line Business Practice Location Address:
1/8 MILE N OF CAMERON CHAPTER HOUSE
Provider Business Practice Location Address City Name:
CAMERON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-283-2672
Provider Business Practice Location Address Fax Number:
928-283-2677
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ENGELKEN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
928-283-2501

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 409449 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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