Provider Demographics
NPI:1649432121
Name:DHHS PHS IHS PHOENIX AREA
Entity type:Organization
Organization Name:DHHS PHS IHS PHOENIX AREA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-572-4100
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366
Mailing Address - Country:US
Mailing Address - Phone:760-572-4100
Mailing Address - Fax:
Practice Address - Street 1:401 PICACHO ROAD
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283
Practice Address - Country:US
Practice Address - Phone:760-572-4100
Practice Address - Fax:760-572-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020211Medicaid
AZP0201800OtherBLUE CROSS
HSZ078OtherMCARE GRP #
AZ092370Medicaid
AZ020211Medicaid