Provider Demographics
NPI:1760547566
Name:COUNTY OF GILA
Entity Type:Organization
Organization Name:COUNTY OF GILA
Other - Org Name:GILA COUNTY DIVISION OF HEALTH AND COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN, BOARD OF SUPERVISORS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-402-8753
Mailing Address - Street 1:107 W FRONTIER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5397
Mailing Address - Country:US
Mailing Address - Phone:928-474-1210
Mailing Address - Fax:928-474-7069
Practice Address - Street 1:107 W FRONTIER ST
Practice Address - Street 2:SUITE A
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5397
Practice Address - Country:US
Practice Address - Phone:928-474-1210
Practice Address - Fax:928-474-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 2220251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2046559Medicaid
AZ486250Medicaid
AZZFL528Medicare PIN