Provider Demographics
NPI:1568739605
Name:DHHS IHS PHOENIX AREA
Entity Type:Organization
Organization Name:DHHS IHS PHOENIX AREA
Other - Org Name:NATIVE AMERICAN CARDIOLOGY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-214-3920
Mailing Address - Street 1:2000 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-214-3920
Mailing Address - Fax:928-214-3924
Practice Address - Street 1:2000 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8759
Practice Address - Country:US
Practice Address - Phone:928-214-3920
Practice Address - Fax:928-214-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty