Provider Demographics
NPI:1790038743
Name:DHHS IHS PHOENIX AREA
Entity Type:Organization
Organization Name:DHHS IHS PHOENIX AREA
Other - Org Name:BYLAS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-475-7348
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:BYLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85530-0149
Mailing Address - Country:US
Mailing Address - Phone:928-475-2686
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 70, MP 295.6
Practice Address - Street 2:
Practice Address - City:BYLAS
Practice Address - State:AZ
Practice Address - Zip Code:85530
Practice Address - Country:US
Practice Address - Phone:928-475-2686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty