San Carlos Apache Healthcare Corporation
Organization Active NPI Durable Medical Equipment & Medical Supplies · Peridot, AZ
NPI 1710475124 · NPPES record last updated May 1, 2018
Key facts
- NPI
- 1710475124
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- Legal business name
- SAN CARLOS APACHE HEALTHCARE CORPORATION
- Practice address
- 103 Medicine Way Road
Peridot, AZ 85542 - Phone
- (928) 475-1400
- Fax
- (928) 475-7371
- NPI assigned
- May 1, 2018
- Organization subpart
- No
Authorized official
- Name
- Valerie J Chee
- Title
- Director Patient Financial Services
- Phone
- (928) 475-1290
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 9
Practitioners 147
-
Manuel Jaymenn Abeyta, FNP-BC
-
Crystal Aroz, FNP
-
Shiv Bagga, MD
-
Nora Barsony, MD
-
Spencer Bigler, FNP
-
Kristina B. Blohm, M.D.
-
Anna Romulda Boron, M.D.
-
Jeffery Burl Bushman, D.O.
-
James Butler, MD
-
Shawna M Carrasco, FNP-C
-
John B Chastain, MD
-
Tyler C Cheatham, FNP
-
Lakota Cheek, MD
-
Edward Chu, MD, MPH
-
Gabriel Rares Colceriu, M.D.
-
Benjamin D Cooper, O.D.
-
Michelle Anne Craft, APRN-RNP, FNP-BC
-
Nicholas Elkins, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200203000667 | AZ | DME Supplier - Indian Health Service Or Tribal Facility | 0648580597 | Practice locations: Peridot, AZ |
National Provider Directory
- Tax ID family
- San Carlos Apache Healthcare Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Yes |
Addresses
Primary practice location
103 Medicine Way Road
Peridot, AZ 85542
Mailing address
PO Box 787
Peridot, AZ 85542-0787
Phone (928) 475-1290
Other practice location 1
101 Medicine Road
Bylas, AZ 85530
Phone (928) 475-1290
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 059898 | Medicaid | AZ | |
| 099458 | Medicaid | AZ |
Other providers in Peridot, AZ
- Jared L Rasmussen
- Renal Dimensions, LLC
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
- San Carlos Apache Healthcare Corporation
- Tamara Scott
- Anna Serey
All providers in Peridot, AZ · Durable Medical Equipment & Medical Supplies in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2018. 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.