Healthcare Provider Details

I. General information

NPI: 1891311171
Provider Name (Legal Business Name): INDIGO HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W 3RD ST STE 1
YUMA AZ
85364-1812
US

IV. Provider business mailing address

1916 N 700 W STE 110
LAYTON UT
84041-5754
US

V. Phone/Fax

Practice location:
  • Phone: 888-253-6598
  • Fax:
Mailing address:
  • Phone: 888-253-6598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER L TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726