NPIMap

Organization Active NPI

San Carlos Apache Tribe

  • Ambulance
  • San Carlos, AZ
National Provider Identifier
1841354263
Registry record updated Feb 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
Legal business name
SAN CARLOS APACHE TRIBE
Practice address
BLD 15 San Carlos Avenue
San Carlos, AZ 85550
Phone
(928) 475-4221
Fax
(928) 475-2885
NPI assigned
Dec 20, 2006
Last updated
Feb 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2015

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

Authorized official

Name
Ms. Cherrill Williams
Title
Director
Phone
(928) 475-4221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X AZ Primary

Addresses

Primary practice location

BLD 15 San Carlos Avenue
San Carlos, AZ 85550

Mailing address

PO Box 0
Hwy 70 Moonbase Road
San Carlos, AZ 85550-0000
Phone (928) 475-2798

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100309000050 AZ Part B Supplier - Ambulance Service Supplier 0345394722 Practice locations: Peridot, AZ

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Carlos Apache Healthcare CorporationPeridot, AZ, CCN 031320 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 12, 2015
Jul 12, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1841354263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 0",
            "address_2": "HWY 70 MOONBASE ROAD",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "855500000",
            "telephone_number": "928-475-2798",
            "fax_number": "928-475-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLD 15 SAN CARLOS AVENUE",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "85550",
            "telephone_number": "928-475-4221",
            "fax_number": "928-475-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CARLOS APACHE TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2015-02-02",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CHERRILL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "928-475-4221",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Carlos, AZ

Sources for this page

Verify at the official NPI Registry.