Provider Demographics
NPI:1114430147
Name:GILA RIVER HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:GILA RIVER HEALTH CARE CORPORATION
Other - Org Name:RED TAIL HAWK HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-528-1427
Mailing Address - Street 1:P.O. BOX 38
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147
Mailing Address - Country:US
Mailing Address - Phone:602-528-1200
Mailing Address - Fax:
Practice Address - Street 1:3042 W. QUEEN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ334582Medicaid