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General NPI Number Information
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NPI Number | 1740497874
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Entity Type | Organization
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Legal Business Name | HUALAPAI TRIBE
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 921 HUALAPAI WAY
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City | PEACH SPRINGS
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State | AZ
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Zip | 86434
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Country | US
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Telephone | 928-769-2656
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Fax | 928-769-2315
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Provider Business Mailing Address
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Address Line | PO BOX 542
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City | PEACH SPRINGS
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State | AZ
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Zip | 86434-0542
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Country | US
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Telephone | 928-769-2656
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Fax | 928-769-2315
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | DEEDRA JEAN TAYLOR
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Credential |
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Telephone | 928-769-2656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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