Healthcare Provider Details

I. General information

NPI: 1326147893
Provider Name (Legal Business Name): NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359-A WEST HIGHWAY 264
ST MICHAELS AZ
86511-0370
US

IV. Provider business mailing address

PO BOX 370
ST MICHAELS AZ
86511-0370
US

V. Phone/Fax

Practice location:
  • Phone: 928-810-3800
  • Fax: 928-810-3811
Mailing address:
  • Phone: 928-810-3800
  • Fax: 928-810-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOTC2967
License Number StateAZ

VIII. Authorized Official

Name: MS. DENIKKA SUE TSOSIE
Title or Position: REVENUE CYCLE SPECIALIST
Credential:
Phone: 928-810-3800