Provider Demographics
NPI: | 1952674038 |
---|---|
Name: | DHHS IHS PHOENIX AREA |
Entity Type: | Organization |
Organization Name: | DHHS IHS PHOENIX AREA |
Other - Org Name: | PARKER INDIAN HOSPITAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DEE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HUTCHISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 928-669-2137 |
Mailing Address - Street 1: | 12033 AGENCY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | PARKER |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85344-7718 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-669-2137 |
Mailing Address - Fax: | 928-669-3232 |
Practice Address - Street 1: | 12033 AGENCY RD |
Practice Address - Street 2: | |
Practice Address - City: | PARKER |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85344-7718 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-669-2137 |
Practice Address - Fax: | 928-669-3232 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-02-20 |
Last Update Date: | 2012-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 092362 | Medicaid |