MEDICARE: TUBA CITY REGIONAL HEALTH CARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1396921870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUBA CITY REGIONAL HEALTH CARE CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 600
Second Line	:
City	:	TUBA CITY
State	:	AZ
Zip	:	86045-0600
Country	:	US
Telephone Number	:	928-283-2501
Fax Number	:	928-283-2677

Provider Business Practice Location Address
First Line	:	10 MILES NE OF SR264 MP362
Second Line	:	ROCKY RIDGE SCHOOL STREET
City	:	KYKOTSMOVI
State	:	AZ
Zip	:	86039
Country	:	US
Telephone Number	:	928-283-2781
Fax Number	:	928-283-2677

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JOSEPH T ENGELKEN
Credential	:
Telephone Number	:	928-283-2501

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	03/19/2014

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