Provider Demographics
NPI:1821321035
Name:APACHE COUNTY PUBLIC HEALTH SERVICES
Entity Type:Organization
Organization Name:APACHE COUNTY PUBLIC HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-337-7532
Mailing Address - Street 1:323 S MOUNTAIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-5102
Mailing Address - Country:US
Mailing Address - Phone:928-333-2415
Mailing Address - Fax:928-333-5876
Practice Address - Street 1:1200 W CLEVELAND
Practice Address - Street 2:SUITE 9
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85938
Practice Address - Country:US
Practice Address - Phone:928-333-2415
Practice Address - Fax:928-333-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4620251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZFL525Medicare PIN