Provider Demographics
NPI:1851359293
Name:DHHS-PHS, IHS TUCSON AREA
Entity Type:Organization
Organization Name:DHHS-PHS, IHS TUCSON AREA
Other - Org Name:IHS TUCSON SANTA ROSA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING AND BUGET OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MBA, CPM
Authorized Official - Phone:520-295-2427
Mailing Address - Street 1:7900 S J STOCK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-7012
Mailing Address - Country:US
Mailing Address - Phone:520-295-2427
Mailing Address - Fax:520-295-2611
Practice Address - Street 1:FEDERAL ROUTE 15
Practice Address - Street 2:
Practice Address - City:SANTA ROSA VILLAGE
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-361-2261
Practice Address - Fax:520-383-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0327177OtherNACADP #
AZ706921-01Medicaid
AZ907008-01Medicaid
AZ147141-03Medicaid
AZAZ0490080OtherBC/BS AZ PROVIDER #
AZ1770581639OtherFACILITY NPI #
AZHSZ171Medicare ID - Type UnspecifiedMEDICARE PART B#
AZ03-0074Medicare Oscar/Certification