Healthcare Provider Details

I. General information

NPI: 1699428847
Provider Name (Legal Business Name): COMMUNITY HEALTH AND IMMUNIZATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14033 N EASTERN AVE
EDMOND OK
73013-5586
US

IV. Provider business mailing address

668 N 44TH ST STE 100W
PHOENIX AZ
85008-6507
US

V. Phone/Fax

Practice location:
  • Phone: 405-645-6002
  • Fax: 480-546-3421
Mailing address:
  • Phone: 844-358-3733
  • Fax: 480-546-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH SUAZO
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 480-646-9099