Healthcare Provider Details

I. General information

NPI: 1215083951
Provider Name (Legal Business Name): DHHS PHS NAIHS SHIPROCK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 160 & NAVAJO ROUTE 35 - RED MESA
TEECNOSPOS AZ
86514
US

IV. Provider business mailing address

HCR 61 BOX 30
TEECNOSPOS AZ
86514
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5000
  • Fax: 505-656-5164
Mailing address:
  • Phone: 928-656-5000
  • Fax: 928-656-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: FANNESSA COMER
Title or Position: CEO
Credential:
Phone: 505-368-6001