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General NPI Number Information
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NPI Number | 1942241443
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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 | 06/08/2006
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 1205 F. AVENUE
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City | DOUGLAS
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State | AZ
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Zip | 85607
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Country | US
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Telephone | 520-364-1429
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Fax | 520-364-4261
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Provider Business Mailing Address
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Address Line | 1205 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 | 520-364-4261
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN MELK
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Credential | MD
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Telephone | 520-364-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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