Provider Demographics
NPI:1083839476
Name:DHHS, PHS, NAIHS, SHIPROCK HOSPITAL
Entity Type:Organization
Organization Name:DHHS, PHS, NAIHS, SHIPROCK HOSPITAL
Other - Org Name:SANOSTEE HEALTH STATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FANNESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-368-6006
Mailing Address - Street 1:IN CARE OF NORTHERN NAVAJO MEDICAL CENTER
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420
Mailing Address - Country:US
Mailing Address - Phone:505-368-6001
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:NAVAJO ROUTE 34
Practice Address - Street 2:
Practice Address - City:SANOSTEE
Practice Address - State:NM
Practice Address - Zip Code:87461
Practice Address - Country:US
Practice Address - Phone:505-368-6001
Practice Address - Fax:505-368-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96174056Medicaid
HSZ069Medicare PIN
NM96174056Medicaid