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General NPI Number Information
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NPI Number | 1497985196
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Entity Type | Organization
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Legal Business Name | DHHS PHS NAIHS SHIPROCK HOSPITAL
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | US HWY 160 & NAVAJO ROUTE 25 - RED MESA
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City | TEECNOSPOS
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State | AZ
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Zip | 86514
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Country | US
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Telephone | 928-656-5000
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Fax | 928-656-5164
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Provider Business Mailing Address
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Address Line | HCR 6100, BOX 30
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City | TEECNOSPOS
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State | AZ
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Zip | 86514
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Country | US
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Telephone | 928-656-5000
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Fax | 928-656-5164
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Authorized Official
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Title or Position | CEO
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Name | FANNESSA COMER
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Credential |
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Telephone | 505-368-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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