NPIMap

Organization Active NPI

The Fort Defiance Indian Hospital Board, Incorporation

Doing business as Fort Defiance Indian Hospital

  • Ambulatory Surgical Clinic/Center
  • Fort Defiance, AZ
National Provider Identifier
1487977914
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION
Doing business as
Fort Defiance Indian Hospital
Practice address
Corner of Route N12 & N7
Fort Defiance, AZ 86504-0649
Phone
(928) 729-8000
Fax
(928) 729-8169
NPI assigned
Mar 11, 2010
Last updated
Jan 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

Name
Dr. Naomi J. Young, MDNPI 1720427222
Title
Chief Executive Officer
Phone
(928) 729-8013

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

Corner of Route N12 & N7
Fort Defiance, AZ 86504-0649

Mailing address

PO Box 649
Fort Defiance, AZ 86504-0649
Phone (928) 729-8000

Other names 1

  • Fort Defiance Indian Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100416000146 TX Part B Supplier - Ambulatory Surgical Center 0941336697 Practice locations: Fort Defiance, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
The Fort Defiance Indian6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1487977914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "928-729-8000",
            "fax_number": "928-729-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE N12 & N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "928-729-8000",
            "fax_number": "928-729-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "928-729-8013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Defiance Indian Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fort Defiance Indian Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Defiance, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.