Healthcare Provider Details

I. General information

NPI: 1396921870
Provider Name (Legal Business Name): TUBA CITY REGIONAL HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MILES NE OF SR264 MP362 ROCKY RIDGE SCHOOL STREET
KYKOTSMOVI AZ
86039
US

IV. Provider business mailing address

PO BOX 600
TUBA CITY AZ
86045-0600
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2781
  • Fax: 928-283-2677
Mailing address:
  • Phone: 928-283-2501
  • Fax: 928-283-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH T ENGELKEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 928-283-2501