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General NPI Number Information
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NPI Number | 1649531377
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Entity Type | Organization
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Legal Business Name | PEACH SPRINGS HEALTH CENTER
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 943 HUALAPAI WAY
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City | PEACH SPRINGS
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State | AZ
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Zip | 86434-0190
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Country | US
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Telephone | 928-769-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 HARRISON ST H157
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City | KINGMAN
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State | AZ
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Zip | 86409-0700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEALTH CENTER DIRECTOR
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Name | ROSEMARY SULLIVAN
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Credential |
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Telephone | 928-769-4369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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