Healthcare Provider Details

I. General information

NPI: 1063965762
Provider Name (Legal Business Name): TOHONO O'ODHAM NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 86 AT TOPAWA ROAD
SELLS AZ
85634-0548
US

IV. Provider business mailing address

PO BOX 810
SELLS AZ
85634-0810
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-7200
  • Fax: 520-383-7216
Mailing address:
  • Phone: 520-383-6000
  • Fax: 520-383-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251K00000X
License Number StateAZ

VIII. Authorized Official

Name: MR. EDWARD MANUEL
Title or Position: CHAIRMAN
Credential:
Phone: 520-383-2028