Provider Demographics
NPI:1467641464
Name:DHHS PHS IHS TUCSON AREA IHS TUCSON SAN XAVIER HEALTH CENTER
Entity Type:Organization
Organization Name:DHHS PHS IHS TUCSON AREA IHS TUCSON SAN XAVIER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITETHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-383-7251
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:520-295-2503
Mailing Address - Fax:520-295-2676
Practice Address - Street 1:7900 S J STOCK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-7012
Practice Address - Country:US
Practice Address - Phone:520-295-2503
Practice Address - Fax:520-295-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5824140001Medicare NSC