1548546609 NPI number — DHHS IHS PHOENIX AREA

Table of content: (NPI 1548546609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548546609 NPI number — DHHS IHS PHOENIX AREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS IHS PHOENIX AREA
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:
BATTLE MOUNTAIN
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:
1548546609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 SHOSHONE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89801-5072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-738-2252
Provider Business Mailing Address Fax Number:
775-748-1455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 MOUNTAIN VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE MOUNTAIN
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89820-1862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-635-8200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELCHERT
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
775-738-2252

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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