Healthcare Provider Details

I. General information

NPI: 1730466608
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

IV. Provider business mailing address

PO BOX 31001-0707
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-2252
  • Fax: 775-748-1455
Mailing address:
  • Phone: 775-738-2252
  • Fax: 775-748-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CATHY E WELCHERT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 775-738-2252