Provider Demographics
NPI:1235238700
Name:NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:SANDERS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-688-3903
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:SANDERS
Mailing Address - State:AZ
Mailing Address - Zip Code:86512
Mailing Address - Country:US
Mailing Address - Phone:928-688-3903
Mailing Address - Fax:928-688-4471
Practice Address - Street 1:RIO VISTA ESTATES LOT #24
Practice Address - Street 2:
Practice Address - City:SANDERS
Practice Address - State:AZ
Practice Address - Zip Code:86512
Practice Address - Country:US
Practice Address - Phone:928-688-3903
Practice Address - Fax:928-688-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3822261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ191513Medicaid