Provider Demographics
NPI:1497205710
Name:KAYENTA HEALTH CENTER, RADIOLOGY DEPT
Entity Type:Organization
Organization Name:KAYENTA HEALTH CENTER, RADIOLOGY DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY MANAGER/ SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-697-4315
Mailing Address - Street 1:15951 W COCOPAH ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7930
Mailing Address - Country:US
Mailing Address - Phone:928-697-4306
Mailing Address - Fax:928-697-4107
Practice Address - Street 1:HIGHWAY 160,
Practice Address - Street 2:KAYENTA HEALTH CENTER
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4306
Practice Address - Fax:928-697-4107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IHS/DHHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNARRT#2718152471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ14256OtherMRTBE