Provider Demographics
NPI:1790539542
Name:CANONCITO BAND OF NAVAJOS HEALTH CENTER
Entity Type:Organization
Organization Name:CANONCITO BAND OF NAVAJOS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-908-2307
Mailing Address - Street 1:PO BOX 3528
Mailing Address - Street 2:
Mailing Address - City:TOHAJIILEE
Mailing Address - State:NM
Mailing Address - Zip Code:87026-3528
Mailing Address - Country:US
Mailing Address - Phone:505-908-2307
Mailing Address - Fax:505-908-2310
Practice Address - Street 1:129 MEDICINE HORSE DRIVE
Practice Address - Street 2:
Practice Address - City:TO'HAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87026-3528
Practice Address - Country:US
Practice Address - Phone:505-908-2307
Practice Address - Fax:505-908-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)