MEDICARE: DHHS, PHS, NAIHS, SHIPROCK HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QD0000X	Dental Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center
3	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780639971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHHS, PHS, NAIHS, SHIPROCK HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 160
Second Line	:	US HIGHWAY 491 NORTH
City	:	SHIPROCK
State	:	NM
Zip	:	87420-0160
Country	:	US
Telephone Number	:	505-368-6401
Fax Number	:	505-368-6431

Provider Business Practice Location Address
First Line	:	US HIGHWAY 491 NORTH
Second Line	:
City	:	SHIPROCK
State	:	NM
Zip	:	87420-0160
Country	:	US
Telephone Number	:	505-368-6401
Fax Number	:	505-368-6431

Authorized Official
Title or Position	:	CEO
Name	:	FANNESSA COMER
Credential	:
Telephone Number	:	505-368-6006

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/23/2008

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Directions to “DHHS, PHS, NAIHS, SHIPROCK HOSPITAL ” Practice Location

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