Provider Demographics
NPI:1336654383
Name:NATIVE HEALTH
Entity Type:Organization
Organization Name:NATIVE HEALTH
Other - Org Name:NATIVE AMERICAN COMMUNITY HEALTH CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-279-5262
Mailing Address - Street 1:4041 N CENTRAL AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3313
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:602-279-5390
Practice Address - Street 1:777 W SOUTHERN AVE
Practice Address - Street 2:BLDG E, STE 501
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5062
Practice Address - Country:US
Practice Address - Phone:480-550-4048
Practice Address - Fax:480-264-5099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIVE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-12
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
AZOTC8483261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527706Medicaid