Basic Information
| Provider Information | |||||||||
| NPI: | 1396921870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TUBA CITY REGIONAL HEALTH CARE CORPORATION | ||||||||
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| OtherOrganizationName: | DINNEBITO HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 600 | ||||||||
| Address2: | |||||||||
| City: | TUBA CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860450600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282832501 | ||||||||
| FaxNumber: | 9282832677 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 MILES NE OF SR264 MP362 | ||||||||
| Address2: | ROCKY RIDGE SCHOOL STREET | ||||||||
| City: | KYKOTSMOVI | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282832781 | ||||||||
| FaxNumber: | 9282832677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | ENGELKEN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9282832501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TUBA CITY REGIONAL HEALTH CARE CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.