Healthcare Provider Details

I. General information

NPI: 1942668991
Provider Name (Legal Business Name): SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 E OSBORN RD
SCOTTSDALE AZ
85256-4019
US

IV. Provider business mailing address

10005 E OSBORN RD
SCOTTSDALE AZ
85256-4019
US

V. Phone/Fax

Practice location:
  • Phone: 480-362-7400
  • Fax: 480-362-5950
Mailing address:
  • Phone: 480-362-7400
  • Fax: 480-362-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE BLAKE
Title or Position: RCM MANAGER
Credential:
Phone: 480-207-9294