1134568660 NPI number — CANYONLANDS COMMUNITY HEALTH CARE

Table of content: DR. HIBA ZAINAB VOHRA MD (NPI 1972399863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134568660 NPI number — CANYONLANDS COMMUNITY HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANYONLANDS COMMUNITY HEALTH CARE
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:
1134568660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1625
Provider Second Line Business Mailing Address:
827 VISTA AVE
Provider Business Mailing Address City Name:
PAGE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86040-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-645-9675
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 WARD CANYON ROAD
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-645-9675
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
928-645-9675

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 031811 . This is a "CORPORATE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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