Healthcare Provider Details

I. General information

NPI: 1124803648
Provider Name (Legal Business Name): CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N F AVE
DOUGLAS AZ
85607-1918
US

IV. Provider business mailing address

1100 N F AVE
DOUGLAS AZ
85607-1919
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-1429
  • Fax:
Mailing address:
  • Phone: 520-364-6860
  • Fax: 520-364-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TAMRA V SPRINGER
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 520-459-3011