NPIMap

Organization Active NPI

San Carlos Apache Healthcare Corporation

  • General Practice Dentistry
  • Peridot, AZ
National Provider Identifier
1356790059
Registry record updated Jun 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SAN CARLOS APACHE HEALTHCARE CORPORATION
Practice address
103 Medicine Way Road
Peridot, AZ 85542
Phone
(928) 475-1200
NPI assigned
Jun 3, 2016
Last updated
Jun 3, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN CARLOS APACHE HEALTHCARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2016

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

Authorized official

Name
Victoria Began
Title
Interim Ceo
Phone
(928) 475-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

103 Medicine Way Road
Peridot, AZ 85542

Mailing address

PO Box 787
Peridot, AZ 85542-0787

National Provider Directory

National Provider Directory
Tax ID family
San Carlos Apache Healthcare Corporation10 organizations share this tax ID, including this one
Part of
San Carlos Apache Healthcare Corporation

Other organizations with this tax ID 9

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": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464912000000",
    "number": "1356790059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 787",
            "city": "PERIDOT",
            "state": "AZ",
            "postal_code": "855420787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MEDICINE WAY ROAD",
            "city": "PERIDOT",
            "state": "AZ",
            "postal_code": "85542",
            "telephone_number": "928-475-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CARLOS APACHE HEALTHCARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN CARLOS APACHE HEALTHCARE CORPORATION",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-03",
        "status": "A",
        "authorized_official_last_name": "BEGAN",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "928-475-1200"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peridot, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; 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.