Active NPI
Stacy Talahytewa II, RT(R)
- Radiologic Technologist
- Polacca, AZ
National Provider Identifier
1871818492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- CRT-10799
- Practice address
- Hwy 264 Mile Post 388
Polacca, AZ 86042 - Phone
- (928) 737-6210
- NPI assigned
- Apr 7, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | CRT-10799 | AZ | Primary |
Addresses
Primary practice location
Hwy 264 Mile Post 388
Polacca, AZ 86042
Mailing address
PO Box 1019
Polacca, AZ 86042-1019
Phone (928) 734-9450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CRT-10799 | AZ | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270598400000",
"number": "1871818492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1019",
"city": "POLACCA",
"state": "AZ",
"postal_code": "860421019",
"telephone_number": "928-734-9450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HWY 264 MILE POST 388",
"city": "POLACCA",
"state": "AZ",
"postal_code": "86042",
"telephone_number": "928-737-6210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TALAHYTEWA",
"first_name": "STACY",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "RT(R)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-07",
"last_updated": "2010-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "AZ",
"license": "CRT-10799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Polacca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.