Provider Demographics
NPI:1952891970
Name:CHANGEPOINT INTEGRATED HEALTH
Entity Type:Organization
Organization Name:CHANGEPOINT INTEGRATED HEALTH
Other - Org Name:CHANGEPOINT INTEGRATED HEALTH SNOWFLAKE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AND CREDENTIALING SPECIALIS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOSPODKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-5315
Mailing Address - Street 1:1801 W DEUCE OF CLUBS STE 100
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2704
Mailing Address - Country:US
Mailing Address - Phone:928-537-5315
Mailing Address - Fax:928-892-5828
Practice Address - Street 1:537 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5279
Practice Address - Country:US
Practice Address - Phone:928-537-5315
Practice Address - Fax:928-892-5828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGEPOINT INTEGRATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC8913261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID