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General NPI Number Information
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NPI Number | 1669441564
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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 | 03/15/2006
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 440 NORTH NAVAJO DRIVE
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City | PAGE
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State | AZ
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Zip | 86040-1625
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Country | US
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Telephone | 928-645-1700
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Fax | 928-645-1701
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Provider Business Mailing Address
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Address Line | PO BOX 1625
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City | PAGE
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State | AZ
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Zip | 86040-1625
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Country | US
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Telephone | 928-645-9675
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Fax | 928-645-3030
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Authorized Official
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Title or Position | CEO
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Name | ELIZABETH G LATHAM
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Credential |
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Telephone | 928-645-9675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | OTC 3854 - DOH
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License Number State | AZ
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