Provider Demographics
NPI:1750508651
Name:NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL, INC.
Other - Org Name:SAGE OUTPATIENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:928-755-4500
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0457
Mailing Address - Country:US
Mailing Address - Phone:928-755-4500
Mailing Address - Fax:928-755-4659
Practice Address - Street 1:ARIZONA HIGHWAY 264 & JUNCTION 191
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:928-755-4659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRGH3899261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033984Medicare Oscar/Certification