1669517868 NPI number — DHHS IHS PHOENIX AREA

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 1669517868 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:
PARKER INDIAN 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:
1669517868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-0699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-0699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12033 AGENCY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85344-7718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-669-2137
Provider Business Practice Location Address Fax Number:
928-669-3131
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY PROGRAM SPECIALIST
Authorized Official Telephone Number:
405-951-6086

Provider Taxonomy Codes

  • Taxonomy code: 332800000X , with the licence number:  AZS05857 , 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: 0324525 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02053701 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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