Provider Demographics
NPI:1649233685
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 PAAPNP
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?CodeTypeClassificationSpecializationGroup
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Not Answered363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchoolGroup - Multi-Specialty
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Not Answered364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0209620OtherBC/BSAZ PROV NO
AZ706921-01Medicaid
AZ1437157302OtherFACILITY NPI #
AZ147133-03Medicaid
AZ1437157302OtherFACILITY NPI #
AZHSZ172Medicare ID - Type UnspecifiedMEDICARE PART B PROV NO.