1487102406 NPI number — US PUBLIC HEALTH COMMISSION CORPS

Table of content: (NPI 1487102406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487102406 NPI number — US PUBLIC HEALTH COMMISSION CORPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US PUBLIC HEALTH COMMISSION CORPS
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:
1487102406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 FERNCLIFF RD
Provider Second Line Business Mailing Address:
PO BOX 274
Provider Business Mailing Address City Name:
RICES LANDING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15357-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-747-5221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 S J STOCK RD
Provider Second Line Business Practice Location Address:
INDIAN HEALTH SERVICE, SAN XAVIER HEALTH CLINIC
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85746-7012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-295-2481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FATH
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
724-747-5221

Provider Taxonomy Codes

  • Taxonomy code: 261QP0904X , with the licence number:  SP012937 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X , with the licence number: SP012937 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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