Healthcare Provider Details

I. General information

NPI: 1790953214
Provider Name (Legal Business Name): DHHS PHS NAIHS FORT DEFIANCE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTE N12 & N7
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 649 CORNER OF ROUTE N12 & N7
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8003
  • Fax: 928-729-8158
Mailing address:
  • Phone: 928-729-8014
  • Fax: 928-729-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number282N00000X
License Number StateAZ

VIII. Authorized Official

Name: DR. FRANKLIN R FREELAND
Title or Position: CEO
Credential:
Phone: 928-729-8014