Healthcare Provider Details

I. General information

NPI: 1558882233
Provider Name (Legal Business Name): CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL STE 600
SIERRA VISTA AZ
85635-2973
US

IV. Provider business mailing address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-8678
  • Fax: 520-459-8423
Mailing address:
  • Phone: 520-364-1429
  • Fax: 250-364-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY007321
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN P MELK
Title or Position: CEO
Credential: MD
Phone: 520-364-6852