Canyonlands Community Health Care
Organization Active NPI Community Health Clinic/Center · Page, AZ
NPI 1619945904 · NPPES record last updated Sep 23, 2021
Key facts
- NPI
- 1619945904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- License
- OTC 0127 (AZ)
- Legal business name
- CANYONLANDS COMMUNITY HEALTH CARE
- Practice address
- 467 Vista Avenue
Page, AZ 86040-1625 - Phone
- (928) 645-8123
- Fax
- (928) 645-3862
- NPI assigned
- Mar 10, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- CANYONDLANDS COMMUNITY HEALTH CARE
Authorized official
- Name
- Christopher J Hansen
- Title
- Ceo
- Phone
- (928) 645-9675
Other NPIs on the same Medicare enrollment 12
Member organizations 1
Practitioners 15
-
Michelle Anne Craft, APRN-RNP, FNP-BC
-
Jeffrey Kiser, APRN
-
Rahsaan Lateef Lindsey, M.D.
-
Seth Curtis Nolan, APRN-RNP
-
Stephanie Schwenn, FNP
-
Janet Thurston, CNM, FNP
-
Ava Zabihi, LPC
-
Lori Lammers, FNP
-
Matthew Marshall, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040219000713 | AZ | Part B Supplier - Clinic/Group Practice | 4082509591 |
Receives reassigned benefits from 42 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Safford, AZ; Pima, AZ; Page, AZ; Globe, AZ; Duncan, AZ; Clifton, AZ; Chilchinbito, AZ; Beaver Dam, AZ |
National Provider Directory
- Part of
- Lake Powell Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Community Health Clinic/Center | 261QC1500X | OTC 0127 | AZ | Yes |
Addresses
Primary practice location
467 Vista Avenue
Page, AZ 86040-1625
Mailing address
PO Box 1625
Page, AZ 86040-1625
Phone (928) 645-9675
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 432857 | Medicaid | AZ |
Other names
- Lake Powell Medical Center
Other providers in Page, AZ
- Daniel Peter Buys
- Samantha Elizabeth Cannavo
- Canyon View Medical Center,LTD
- Canyonlands Community Health Care
- Canyonlands Community Health Care
- Canyonlands Community Health Care
- Canyonlands Community Health Care
- Canyonlands Community Healthcare - BH
- Care for You, PC
- Ryan Matthew Carr
All providers in Page, AZ · Community Health 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 Sep 23, 2021. 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.