1780639971 NPI number — DHHS, PHS, NAIHS, SHIPROCK HOSPITAL

Table of content: (NPI 1780639971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780639971 NPI number — DHHS, PHS, NAIHS, SHIPROCK HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS, PHS, NAIHS, SHIPROCK HOSPITAL
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:
NORTHERN NAVAJO MEDICAL CENTER
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:
1780639971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
US HIGHWAY 491 NORTH
Provider Business Mailing Address City Name:
SHIPROCK
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87420-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-368-6401
Provider Business Mailing Address Fax Number:
505-368-6431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US HIGHWAY 491 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPROCK
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87420-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-368-6401
Provider Business Practice Location Address Fax Number:
505-368-6431
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMER
Authorized Official First Name:
FANNESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
505-368-6006

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020503 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: H6785 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7000000092 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7000000084 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95017950 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80796 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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