Provider Demographics
NPI:1457311417
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 DIETARY
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:BA, 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 AT 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:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1487643284OtherPHARMACY NPI #
AZ706921-01Medicaid
AZ0325642OtherNACADP #
AZ1255304648OtherEYE AND VISION NPI #
AZ1487652426OtherFACILITY NPI NO
AZ1457321234OtherBEHAVIORAL HLTH NPI #
AZ1558344358OtherDENTAL NPI #
AZ1215936018OtherEMS NPI #
AZAZ0209580OtherBC/BSAZ PROV NO
AZ020579-03Medicaid
AZAZ0209610OtherBC/BSAZ DENTAL PROV NO
AZ706921-01Medicaid
AZ020579-03Medicaid