Provider Demographics
NPI:1326147893
Name:NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:ST. MICHAELS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DENIKKA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TSOSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-810-3800
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0370
Mailing Address - Country:US
Mailing Address - Phone:928-810-3800
Mailing Address - Fax:928-810-3811
Practice Address - Street 1:359-A WEST HIGHWAY 264
Practice Address - Street 2:
Practice Address - City:ST MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511-0370
Practice Address - Country:US
Practice Address - Phone:928-810-3800
Practice Address - Fax:928-810-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC2967261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ709248Medicaid
NM68357303Medicaid
NM68357303Medicaid