Healthcare Provider Details

I. General information

NPI: 1689951220
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 70, MP 295.6
BYLAS AZ
85530
US

IV. Provider business mailing address

PO BOX 149
BYLAS AZ
85530-0149
US

V. Phone/Fax

Practice location:
  • Phone: 928-475-2686
  • Fax:
Mailing address:
  • Phone: 928-475-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NELLA J. BEN
Title or Position: CEO
Credential:
Phone: 928-475-7347