1427335181 NPI number — DHHS IHS PHOENIX AREA

Table of content: (NPI 1427335181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427335181 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:
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:
1427335181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITERIVER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85941-0860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-338-5509
Provider Business Mailing Address Fax Number:
928-338-5508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTH CROMWELL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIBECUE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-332-2560
Provider Business Practice Location Address Fax Number:
928-338-5508
Provider Enumeration Date:
11/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
928-338-4911

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)

  • Identifier: 020561 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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