MEDICARE: GILA RIVER HEALTH CARE CORPORATION

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1700867819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILA RIVER HEALTH CARE CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 2176
Second Line	:
City	:	SACATON
State	:	AZ
Zip	:	85247-2176
Country	:	US
Telephone Number	:	602-271-7901
Fax Number	:	602-271-7970

Provider Business Practice Location Address
First Line	:	9721 W. PECOS ROAD
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339
Country	:	US
Telephone Number	:	520-550-6050
Fax Number	:	520-550-6051

Authorized Official
Title or Position	:	CFO
Name	:	MARY JUDITH ROTH
Credential	:
Telephone Number	:	602-528-1200

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/27/2024

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