Basic Information
| Provider Information | |||||||||
| NPI: | 1801314000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALT RIVER PIMA MARICOPA INDIAN COMMUNITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10005 E OSBORN RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852564019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022631200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10005 E OSBORN RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852564019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022631200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL-ENOS | ||||||||
| AuthorizedOfficialFirstName: | VIOLET | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HEALTH & HUMAN SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4803625500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP0905X | Y | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local |
No ID Information.