NPIMap

Organization Active NPI

Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

Doing business as Gila Bend Clinic Professional Services

  • Family Medicine Physician
  • Gila Bend, AZ
National Provider Identifier
1831245661
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Doing business as
Gila Bend Clinic Professional Services
Practice address
100 North Gila Boulevard
Gila Bend, AZ 85227-2658
Phone
(602) 263-1200
Fax
(602) 263-1618
NPI assigned
Jan 26, 2007
Last updated
Jun 19, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
DHEW IND HLTH SVS HLTH SVS & MNTL HLTH ADMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

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

Authorized official

Name
Miss Deanna J. Dick, MSW., MHA.
Title
(Ceo) Chief Executive Officer
Phone
(602) 263-1567

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X NU
Psychologist 103T00000X NU
Clinical Social Worker 1041C0700X NU
Registered Dietitian 133V00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

100 North Gila Boulevard
Gila Bend, AZ 85227-2658

Mailing address

PO Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1200

Other identifiers 1

IdentifierTypeStateIssuer
812851MedicaidAZ

Other names 1

  • Gila Bend Clinic Professional Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dhew Ind HTLH SV HLTH S18 organizations share this tax ID, including this one
Part of
Dhew Ind HTLH SV HLTH S

Other organizations with this tax ID 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1831245661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-0698",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100698",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NORTH GILA BOULEVARD",
            "city": "GILA BEND",
            "state": "AZ",
            "postal_code": "852272658",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DHEW IND HLTH SVS HLTH SVS & MNTL HLTH ADM",
        "enumeration_date": "2007-01-26",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "DICK",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "(CEO) CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-263-1567",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MSW., MHA."
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "812851",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gila Bend Clinic Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gila Bend, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.