Provider Demographics
NPI:1417007170
Name:THE HOPI TRIBE
Entity Type:Organization
Organization Name:THE HOPI TRIBE
Other - Org Name:HOPI TRIBAL ACTIVITIES
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-737-6355
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:POLACCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86042-1010
Mailing Address - Country:US
Mailing Address - Phone:928-737-6355
Mailing Address - Fax:928-737-6046
Practice Address - Street 1:HWY 264 MP 388
Practice Address - Street 2:
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6355
Practice Address - Fax:928-737-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ310912Medicaid
AZ310912Medicaid