Provider Demographics
NPI:1922253129
Name:DHHS PHS NAIHS CHINLE COMPREHENSIVE
Entity Type:Organization
Organization Name:DHHS PHS NAIHS CHINLE COMPREHENSIVE
Other - Org Name:CHINLE COMPREHENIVE HEALTH CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-674-7030
Mailing Address - Street 1:PO BOX PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-8000
Mailing Address - Country:US
Mailing Address - Phone:928-674-7030
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:HOSPITAL ROAD OFF HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7030
Practice Address - Fax:928-674-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAC0001OtherMEDICARE ASC PROVIDER NUMBER