Provider Demographics
NPI:1679876551
Name:FORT DEFIANCE INDIAN HOSPITAL BOARD, INC
Entity Type:Organization
Organization Name:FORT DEFIANCE INDIAN HOSPITAL BOARD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-729-8013
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:NW CORNER OF NAVAJO RT. 12 AND 7
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NW CORNER OF NAVAJO RT. 12 AND 7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19487282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital