Healthcare Provider Details

I. General information

NPI: 1265719934
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 HUALAPAI WAY
PEACH SPRINGS AZ
86434-0190
US

IV. Provider business mailing address

PO BOX 190
PEACH SPRINGS AZ
86434-0190
US

V. Phone/Fax

Practice location:
  • Phone: 928-769-2900
  • Fax: 928-769-2701
Mailing address:
  • Phone: 928-769-2900
  • Fax: 928-769-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA R CHAMBERLAIN
Title or Position: PATIENT BUSINESS OFFICE
Credential:
Phone: 928-769-2918