1568636116 NPI number — HUALAPAI HEALTH DEPARTMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568636116 NPI number — HUALAPAI HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUALAPAI HEALTH DEPARTMENT
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:
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:
1568636116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 397
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACH SPRINGS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86434-0397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-769-2207
Provider Business Mailing Address Fax Number:
928-769-2588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 RODEO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEACH SPRINGS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-769-2207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH DEPARTMENT DIRECTOR
Authorized Official Telephone Number:
928-769-2207

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  CMS CERTIFICATION ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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