Healthcare Provider Details

I. General information

NPI: 1780639971
Provider Name (Legal Business Name): DHHS, PHS, NAIHS, SHIPROCK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HIGHWAY 491 NORTH
SHIPROCK NM
87420-0160
US

IV. Provider business mailing address

PO BOX 160 US HIGHWAY 491 NORTH
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6401
  • Fax: 505-368-6431
Mailing address:
  • Phone: 505-368-6401
  • Fax: 505-368-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: FANNESSA COMER
Title or Position: CEO
Credential:
Phone: 505-368-6006