Provider Demographics
NPI:1902189905
Name:GILA RIVER HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:GILA RIVER HEALTH CARE CORPORATION
Other - Org Name:KOMATKE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-528-1470
Mailing Address - Street 1:17487 S. HEALTH CARE DR.
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-0038
Mailing Address - Country:US
Mailing Address - Phone:520-550-6000
Mailing Address - Fax:520-550-6027
Practice Address - Street 1:17487 S. HEALTH CARE DR.
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-0038
Practice Address - Country:US
Practice Address - Phone:520-550-6000
Practice Address - Fax:520-550-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEZ055OtherMEDICARE GROUP PTAN