Northern Apache County Special Health Care District

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OTC2967 Issued in AZ

Legal business name

NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT

Doing business as

St. Michaels Clinic

Practice address

359 West Highway 264
Suite a
Saint Michaels, AZ 86511

Phone

(928) 810-3800

Fax

(928) 810-3801

NPI assigned

Dec 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Dawn Martinez

Title

Business Office Manager

Phone

(928) 810-3814

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• St. Michaels Clinic Doing business as

Tax ID family

Northern Apache County Special Health Care District3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Northern Apache County Special Health Care District

  • Pharmacy
  • Saint Michaels, AZ
  • NPI 1043467749
  NPD tax ID
• Northern Apache County Special Health Care District

  • Primary Care Clinic/Center
  • Sanders, AZ
  • NPI 1629209622
  NPD tax ID

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198454400000",
    "number": "1679757819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "SAINT MICHAELS",
            "state": "AZ",
            "postal_code": "865110370",
            "telephone_number": "928-810-3814",
            "fax_number": "928-810-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 WEST HIGHWAY 264",
            "address_2": "SUITE A",
            "city": "SAINT MICHAELS",
            "state": "AZ",
            "postal_code": "86511",
            "telephone_number": "928-810-3800",
            "fax_number": "928-810-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN APACHE COUNTY SPECIAL HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "928-810-3814",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "OTC2967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "709248",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68357303",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Michaels Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan L Elizondo, M.D.
• Patricia F Hogan, LCSW, LMT
• Erica Lynn Kish, PT, MPT
• Northern Apache County Special Health Care District
• Northern Apache County Special Health Care District
• Professional Behavioral Health Services of St. Michaels
• Sacred Mountain Home Care
• Sacred Sun Transport
• Sequel Tsi of Az, LLC
• St. Michaels Association for Special Education

• Family Medicine Physician in Saint Michaels, AZ
• Providers in Saint Michaels, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; 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.