NPIMap

Organization Active NPI

DHHS IHS Phoenix Area

  • Dental Clinic/Center
  • Cibecue, AZ
National Provider Identifier
1184874034
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DHHS IHS PHOENIX AREA
Practice address
North Cromwell Road
Cibecue, AZ 85911
Phone
(928) 332-2560
Fax
(928) 338-5508
NPI assigned
Sep 29, 2008
Organization subpart
Yes
Parent organization
DHHS IHS PHOENIX AREAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Michelle Martinez, FNP
Title
Chief Executive Officer
Phone
(928) 338-4911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

North Cromwell Road
Cibecue, AZ 85911

Mailing address

P.O. Box 860
200 Hospital Drive
Whiteriver, AZ 85941-0860
Phone (928) 338-4911

Other identifiers 1

IdentifierTypeStateIssuer
092461MedicaidAZ

Other names 1

  • Cibecue Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Whiteriver Service Unit9 organizations share this tax ID, including this one
Part of
Whiteriver Service Unit

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1184874034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 860",
            "address_2": "200 HOSPITAL DRIVE",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859410860",
            "telephone_number": "928-338-4911",
            "fax_number": "928-338-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NORTH CROMWELL ROAD",
            "city": "CIBECUE",
            "state": "AZ",
            "postal_code": "85911",
            "telephone_number": "928-332-2560",
            "fax_number": "928-338-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHHS IHS PHOENIX AREA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DHHS IHS PHOENIX AREA",
        "enumeration_date": "2008-09-29",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "928-338-4911",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092461",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cibecue",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cibecue, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.