St Johns Concho Senior Citizens Assoc

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

P0496 Issued in AZ

Legal business name

ST JOHNS CONCHO SENIOR CITIZENS ASSOC

Practice address

395 South First West St
St Johns Concho Senior Citizens Assoc
St Johns, AZ 85936-0887

Phone

(928) 337-2144

Fax

(928) 337-2581

NPI assigned

Mar 13, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Betty Jo Clanton, MEMBER OF SENIOR BRD

Title

President

Phone

(928) 337-2144

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1093986499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "ST JOHNS",
            "state": "AZ",
            "postal_code": "859360887",
            "telephone_number": "928-337-2144",
            "fax_number": "928-337-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 SOUTH FIRST WEST ST",
            "address_2": "ST JOHNS CONCHO SENIOR CITIZENS ASSOC",
            "city": "ST JOHNS",
            "state": "AZ",
            "postal_code": "859360887",
            "telephone_number": "928-337-2144",
            "fax_number": "928-337-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS CONCHO SENIOR CITIZENS ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "CLANTON",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-337-2144",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MEMBER OF SENIOR BRD"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "AZ",
            "license": "P0496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "351560",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Joseph Donovan Tenney, D.D.S.

• Voluntary or Charitable Agency in St Johns, AZ
• Providers in St Johns, AZ by specialty
• Voluntary or Charitable Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.