Healthcare Provider Details

I. General information

NPI: 1629380274
Provider Name (Legal Business Name): SEAN WARD RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 191 & HOSPITAL ROAD CHINLE COMPREHENSIVE HEALTH CARE FACILITY
CHINLE AZ
86503
US

IV. Provider business mailing address

P.O. DRAWER PH CHINLE COMPREHENSIVE HEALTH CARE FACILITY
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7001
  • Fax: 928-674-7705
Mailing address:
  • Phone: 928-674-7246
  • Fax: 928-674-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number007826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: