Provider Demographics
NPI:1407818347
Name:DHHS-PHS, IHS TUCSON AREA, IHS TUCSON
Entity Type:Organization
Organization Name:DHHS-PHS, IHS TUCSON AREA, IHS TUCSON
Other - Org Name:SELLS INDIAN HOSPITAL PODIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTING AND BUDGET OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPM
Authorized Official - Phone:520-295-2427
Mailing Address - Street 1:7900 S J STOCK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-7012
Mailing Address - Country:US
Mailing Address - Phone:520-295-2427
Mailing Address - Fax:520-295-2611
Practice Address - Street 1:HIGHWAY 86 @ TOPAWA ROAD
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-383-7251
Practice Address - Fax:520-383-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Not Answered213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020579-03Medicaid
AZ706921-01Medicaid
AZAZ0209580OtherBCBSAZ PROVIDER #
AZ907008-01Medicaid
AZ020579-03Medicaid
AZAZ0209580OtherBCBSAZ PROVIDER #