Healthcare Provider Details

I. General information

NPI: 1427213479
Provider Name (Legal Business Name): TUBA CITY REGIONAL HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 NORTH MAIN STREET
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

PO BOX 600
TUBA CITY AZ
86045-0600
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2501
  • Fax: 928-283-2677
Mailing address:
  • Phone: 928-283-2501
  • Fax: 928-283-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LYNETTE BONAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 928-283-2501