Provider Demographics
NPI:1235268996
Name:DHHS PHS NAIHS SHIPROCK HOSPITAL
Entity Type:Organization
Organization Name:DHHS PHS NAIHS SHIPROCK HOSPITAL
Other - Org Name:NORTHERN NAVAJO MEDICAL CENTER - PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SYSTEM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-368-6001
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-7250
Mailing Address - Fax:
Practice Address - Street 1:US HWY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-7252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2022-10-31
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
3209093OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NM67935Medicaid
2058197OtherPK