Healthcare Provider Details

I. General information

NPI: 1881147510
Provider Name (Legal Business Name): TOHONO O'ODHAM NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST HIGHWAY 86, MILE MARKER 74 SAN SIMON VILLAGE
SELLS AZ
85634
US

IV. Provider business mailing address

PO BOX 810
SELLS AZ
85634-0810
US

V. Phone/Fax

Practice location:
  • Phone: 520-362-7003
  • Fax: 520-362-7009
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 Number
License Number State

VIII. Authorized Official

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