Provider Demographics
NPI:1932468741
Name:ARIZONA INDIAN HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ARIZONA INDIAN HEALTH SERVICES, LLC
Other - Org Name:ARIZONA INTEGRATED HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-467-4733
Mailing Address - Street 1:13236 N 7TH ST
Mailing Address - Street 2:STE 4 # 305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5343
Mailing Address - Country:US
Mailing Address - Phone:602-467-4733
Mailing Address - Fax:602-331-5483
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:602-467-4733
Practice Address - Fax:602-331-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty