NPIMap

Organization Active NPI

Fort Defiance Indian Hospital Board, Inc.

  • Chronic Disease Hospital
  • Fort Defiance, AZ
National Provider Identifier
1710273040
Registry record updated Jun 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Chronic Disease HospitalTaxonomy code 281P00000X
License
LPO42607 Issued in AZ
Legal business name
FORT DEFIANCE INDIAN HOSPITAL BOARD, INC.
Practice address
Corner of Route 12 & N7
Fort Defiance, AZ 86504
Phone
(928) 729-8000
NPI assigned
Jun 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2011

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

Authorized official

Name
Jennie Gould
Title
Licensed Practical Nurse
Phone
(928) 729-8030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chronic Disease Hospital 281P00000X LPO42607 AZ Primary

Addresses

Primary practice location

Corner of Route 12 & N7
Fort Defiance, AZ 86504

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Fort Defiance Indian Hospital Board Inc6 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.

NPI Registry JSON

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308873600000",
    "number": "1710273040",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE 12 & N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT DEFIANCE INDIAN HOSPITAL BOARD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-24",
        "last_updated": "2011-06-24",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_title_or_position": "LICENSED PRACTICAL NURSE",
        "authorized_official_telephone_number": "928-729-8030"
    },
    "taxonomies": [
        {
            "code": "281P00000X",
            "taxonomy_group": "",
            "desc": "Chronic Disease Hospital",
            "state": "AZ",
            "license": "LPO42607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 24, 2011; 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.