Provider Demographics
NPI: | 1629031596 |
---|---|
Name: | DHHS-PHS, IHS TUCSON AREA, IHS TUCSON SAN XAVIER CLINIC |
Entity Type: | Organization |
Organization Name: | DHHS-PHS, IHS TUCSON AREA, IHS TUCSON SAN XAVIER CLINIC |
Other - Org Name: | SAN XAVIER CLINIC TTOTSP |
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: | 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: | 520-295-2427 |
Practice Address - Fax: | 520-295-2611 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-04-10 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 246QC1000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Chemistry | Group - Multi-Specialty |
Not Answered | 246QL0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Laboratory Management | Group - Multi-Specialty |
Not Answered | 246QM0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Microbiology | Group - Multi-Specialty |
Not Answered | 246RM2200X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Medical Laboratory | Group - Multi-Specialty |
Not Answered | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy | Group - Multi-Specialty |
Not Answered | 246YC3301X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Health Information | Coding Specialist, Hospital Based | Group - Multi-Specialty |
Not Answered | 246YR1600X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Health Information | Registered Record Administrator | Group - Multi-Specialty |
Not Answered | 2471C3402X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 1437157302 | Other | FACILITY NPI # |
AZ | 706921-01 | Medicaid | |
AZ | AZ0209620 | Other | BC/BSAZ PROV NO |
AZ | 147133-03 | Medicaid | |
AZ | 706921-01 | Medicaid | |
AZ | 03-0074 | Medicare Oscar/Certification |