Healthcare Provider Details

I. General information

NPI: 1447288436
Provider Name (Legal Business Name): SACRED MOUNTAIN MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NP-39 MOENAVE RD/LOLMA ST
TUBA CITY AZ
86045
US

IV. Provider business mailing address

PO BOX 2290
TUBA CITY AZ
86045-2290
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-8243
  • Fax: 928-283-8237
Mailing address:
  • Phone: 928-283-8243
  • Fax: 928-283-8237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number127
License Number StateAZ

VIII. Authorized Official

Name: DANNY BARNEY
Title or Position: OWNER
Credential:
Phone: 928-283-8243