Provider Demographics
NPI:1740497874
Name:HUALAPAI TRIBE
Entity type:Organization
Organization Name:HUALAPAI TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-769-2656
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:PEACH SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86434-0542
Mailing Address - Country:US
Mailing Address - Phone:928-769-2656
Mailing Address - Fax:928-769-2315
Practice Address - Street 1:921 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434
Practice Address - Country:US
Practice Address - Phone:928-769-2656
Practice Address - Fax:928-769-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146523Medicaid
AZZRMBBFMedicare ID - Type Unspecified