1760666739 NPI number — DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY

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 1760666739 NPI number — DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
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:
IHS TSAILE DENTAL
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:
1760666739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER PH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINLE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-674-7001
Provider Business Mailing Address Fax Number:
928-674-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OFF HWY 191 & HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-7001
Provider Business Practice Location Address Fax Number:
928-674-7008
Provider Enumeration Date:
12/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YAZZIE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
928-674-7030

Provider Taxonomy Codes

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

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

  • Identifier: 085648 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com