The Fort Defiance Indian Hospital Board, Incorporation
Organization Active NPI Ambulatory Surgical Clinic/Center · Fort Defiance, AZ
NPI 1487977914 · NPPES record last updated Jan 3, 2025
Key facts
- NPI
- 1487977914
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION
- 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Naomi J. Young, MD
- Title
- Chief Executive Officer
- Phone
- (928) 729-8013
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 5
Practitioners 198
-
Andrea Arroyo, CRNP
-
Cherno Bah, PMH-NP
-
Kathryn Barron, ANP
-
Roger Victor Begay, M.D.
-
Iris Alexis Bekis, LMSW
-
Brian Bells Carino, M.D.
-
James Edward Coyle II, D.O.
-
Kelvin Dan, M.D.
-
Benjamin Dodge, MD
-
Dennis L Frew, D.O.
-
Busanda Lee Frost, ARNP
-
Roberta S. Johnson-Seay, ARNP-C
-
Kevin A Lewellen, CRNA
-
Beth Meneely, CRNA
-
Jennifer Elaine Nydam, R.N., C.N.M.
-
Hannah Christine Palm, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100416000146 | TX | Part B Supplier - Ambulatory Surgical Center | 0941336697 | Practice locations: Fort Defiance, AZ |
National Provider Directory
- Tax ID family
- Fort Defiance Indian Hospital Board Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341607 | Medicaid | AZ | |
| 523053 | Medicaid | AZ | |
| H0010 | Medicaid | NM |
Other names
- Fort Defiance Indian Hospital
Other providers in Fort Defiance, AZ
- Laura Tape
- Melissa L Taylor
- Dale Tennyson
- The Fort Defiance Indian Hospital Board, Incorporation
- The Fort Defiance Indian Hospital Board, Incorporation
- Christopher David Thirkill
- Jihan Thomas
- Charlotte Thompson
- Ilene Thompson
- John R Thompson
All providers in Fort Defiance, AZ · Ambulatory Surgical Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.