Healthcare Provider Details

I. General information

NPI: 1851979801
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W HOSPITAL DR
WHITERIVER AZ
85941-0820
US

IV. Provider business mailing address

PO BOX 860
WHITERIVER AZ
85941-0860
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4911
  • Fax: 928-338-5508
Mailing address:
  • Phone: 928-338-4911
  • Fax: 928-338-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RACHEAL ALLEN
Title or Position: REVENUE MANAGER
Credential:
Phone: 928-338-4911