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General NPI Number Information
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NPI Number | 1598052466
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Entity Type | Organization
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Legal Business Name | CANYONLANDS COMMUNITY HEALTH CARE
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 618 S CENTRAL AVE
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City | SAFFORD
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State | AZ
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Zip | 85546-2721
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Country | US
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Telephone | 928-428-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 618 S CENTRAL AVE
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City | SAFFORD
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State | AZ
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Zip | 85546-2721
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Country | US
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Telephone | 928-428-1500
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Fax |
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Authorized Official
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Title or Position | SITE DIRECTOR
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Name | DR. JOHN PAUL NESTOR
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Credential | D.O.
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Telephone | 928-428-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 3915
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License Number State | AZ
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