Provider Demographics
NPI:1093813222
Name:COUNTY OF NAVAJO
Entity Type:Organization
Organization Name:COUNTY OF NAVAJO
Other - Org Name:NAVAJO COUNTY PUBLIC HEALTH SERVICES DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:KARTCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-532-6050
Mailing Address - Street 1:251 N PENROD RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-9528
Mailing Address - Country:US
Mailing Address - Phone:928-532-6050
Mailing Address - Fax:928-532-6054
Practice Address - Street 1:251 N PENROD RD
Practice Address - Street 2:UNIT 1
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-9528
Practice Address - Country:US
Practice Address - Phone:928-532-6050
Practice Address - Fax:928-532-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23164251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113603Medicare PIN