Provider Demographics
NPI:1417331711
Name:CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-364-1429
Mailing Address - Street 1:1205 F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:155 CALLE PORTAL
Practice Address - Street 2:SUITE 300
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-459-3011
Practice Address - Fax:520-364-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7227261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ043871Medicaid
AZZWDBXSMedicare UPIN