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General NPI Number Information
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NPI Number | 1558882233
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Entity Type | Organization
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Legal Business Name | CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 155 CALLE PORTAL STE 600
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2973
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Country | US
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Telephone | 520-515-8678
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Fax | 520-459-8423
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Provider Business Mailing Address
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Address Line | 1205 N F AVE
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City | DOUGLAS
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State | AZ
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Zip | 85607-1920
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Country | US
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Telephone | 520-364-1429
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Fax | 250-364-4261
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN P MELK
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Credential | MD
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Telephone | 520-364-6852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y007321
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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