Healthcare Provider Details

I. General information

NPI: 1336278597
Provider Name (Legal Business Name): DHHS PHS NAIHS SHIPROCK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ROAD 7586
BLOOMFIELD NM
87413-4934
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-8144
  • Fax: 505-368-8009
Mailing address:
  • Phone: 505-368-8144
  • Fax: 505-368-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBINA HARVEY
Title or Position: HEALTH SYSTEM ADMINISTRATOR
Credential:
Phone: 505-368-6001