NPIMap

Organization Active NPI

San Carlos Apache Tribe

  • Registered Dietitian
  • San Carlos, AZ
National Provider Identifier
1912030370
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
85002233 Issued in AZ
Legal business name
SAN CARLOS APACHE TRIBE
Practice address
1 Mohave Avenue
San Carlos, AZ 85550
Phone
(928) 475-2798
Fax
(928) 475-5925
NPI assigned
Mar 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Wendsler Nosie
Title
Tribal Chairman
Phone
(928) 475-2361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X 85002233 AZ Primary

Addresses

Primary practice location

1 Mohave Avenue
San Carlos, AZ 85550

Mailing address

PO Box 0
San Carlos, AZ 85550
Phone (928) 475-2798

Other identifiers 1

IdentifierTypeStateIssuer
153159MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
San Carlos Apache Tribe7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912030370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 0",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "85550",
            "telephone_number": "928-475-2798",
            "fax_number": "928-475-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MOHAVE AVENUE",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "85550",
            "telephone_number": "928-475-2798",
            "fax_number": "928-475-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CARLOS APACHE TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NOSIE",
        "authorized_official_first_name": "WENDSLER",
        "authorized_official_title_or_position": "TRIBAL CHAIRMAN",
        "authorized_official_telephone_number": "928-475-2361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "AZ",
            "license": "85002233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153159",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Carlos, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.