MEDICARE: DHHS-PHS, IHS TUCSON AREA, IHS TUCSON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223P0221X	Pediatric Dentistry
2	124Q00000X	Dental Hygienist
3	126800000X	Dental Assistant
4	1223D0001X	Public Health Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1487652426	OTHER	AZ	FACILITY NPI #
3	1558344358	OTHER	AZ	DENTAL NPI #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0325642	OTHER	AZ	NACADP #

General Provider Information

NPI Number	:	1558344358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHHS-PHS, IHS TUCSON AREA, IHS TUCSON

Provider Business Mailing Address
First Line	:	7900 S J STOCK RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-7012
Country	:	US
Telephone Number	:	520-295-2427
Fax Number	:	520-295-2611

Provider Business Practice Location Address
First Line	:	HIGHWAY 86 AND TOPAWA ROAD
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634
Country	:	US
Telephone Number	:	520-383-7251
Fax Number	:	520-383-7216

Authorized Official
Title or Position	:	ACCOUNTING AND BUDGET OFFICER
Name	:	MR. KURT PRIESSMAN
Credential	:	B.A., M.B.A., C.P.M.
Telephone Number	:	520-295-2427

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	01/15/2008

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Directions to “DHHS-PHS, IHS TUCSON AREA, IHS TUCSON ” Practice Location

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