Provider Demographics
NPI:1033437884
Name:GILA RIVER HEALTH CARE CORPORTION
Entity Type:Organization
Organization Name:GILA RIVER HEALTH CARE CORPORTION
Other - Org Name:HU HU KAM MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEMBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-528-1200
Mailing Address - Street 1:483 W. SEED FARM RD.
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-0115
Mailing Address - Country:US
Mailing Address - Phone:602-528-1340
Mailing Address - Fax:602-528-1296
Practice Address - Street 1:483 W. SEED FARM RD.
Practice Address - Street 2:CREDENTIALING
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-0115
Practice Address - Country:US
Practice Address - Phone:602-528-1340
Practice Address - Fax:602-528-1296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILA RIVER HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTRIBAL282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEZ054Medicare PIN