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General NPI Number Information
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NPI Number | 1053418533
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Entity Type | Organization
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Legal Business Name | FORT MCDOWELL YAVAPAI NATION
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 16240 NORTH FORT MCDOWELL
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City | FORT MCDOWELL
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State | AZ
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Zip | 85264-3402
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Country | US
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Telephone | 480-789-7890
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Fax | 480-789-7894
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Provider Business Mailing Address
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Address Line | PO BOX 17779
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85269-7779
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Country | US
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Telephone | 480-789-7890
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Fax | 480-789-7894
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Authorized Official
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Title or Position | MEDICAL HEALTH DIRECTOR
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Name | DEMETRA BARR REYNOLDS
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Credential | MD
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Telephone | 480-816-7199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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