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General NPI Number Information
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NPI Number | 1356628028
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Entity Type | Organization
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Legal Business Name | DHHS IHS PHOENIX AREA
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | HIGHWAY 264 MILEPOST 388
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City | POLACCA
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State | AZ
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Zip | 86042-4000
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Country | US
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Telephone | 928-737-6000
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Fax | 928-737-6080
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Provider Business Mailing Address
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Address Line | HIGHWAY 264 MILEPOST 388 PO BOX 4000
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City | POLACCA
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State | AZ
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Zip | 86042-4000
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Country | US
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Telephone | 928-737-6000
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Fax | 928-737-6080
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Authorized Official
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Title or Position | CEO
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Name | DARYL MELVIN
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Credential |
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Telephone | 928-737-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 366937
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License Number State | AZ
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