MEDICARE: NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	OTC2967	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326147893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	ST MICHAELS
State	:	AZ
Zip	:	86511-0370
Country	:	US
Telephone Number	:	928-810-3800
Fax Number	:	928-810-3811

Provider Business Practice Location Address
First Line	:	359-A WEST HIGHWAY 264
Second Line	:
City	:	ST MICHAELS
State	:	AZ
Zip	:	86511-0370
Country	:	US
Telephone Number	:	928-810-3800
Fax Number	:	928-810-3811

Authorized Official
Title or Position	:	REVENUE CYCLE SPECIALIST
Name	:	MS. DENIKKA SUE TSOSIE
Credential	:
Telephone Number	:	928-810-3800

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/28/2022

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Directions to “NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT ” Practice Location

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