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San Carlos Apache Healthcare Corporation

Organization Active NPI Family Medicine Physician · Peridot, AZ

NPI 1992154694 · NPPES record last updated Jun 3, 2016

Key facts

NPI
1992154694
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
SAN CARLOS APACHE HEALTHCARE CORPORATION
Practice address
103 Medicine Way Road
Peridot, AZ 85542
Phone
(928) 475-1200
NPI assigned
Jun 3, 2016
Organization subpart
Yes
Parent organization (as reported)
SAN CARLOS APACHE HEALTHCARE CORPORATION

Authorized official

Name
Victoria Began
Title
Interim Ceo
Phone
(928) 475-1200

Corporate family (same tax ID) 9

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

National Provider Directory

Tax ID family
San Carlos Apache Healthcare Corporation (10 organizations share this tax ID)
Part of
San Carlos Apache Healthcare Corporation

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207P00000X
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X

Addresses

Primary practice location

103 Medicine Way Road
Peridot, AZ 85542

Mailing address

PO Box 787
Peridot, AZ 85542-0787

Other providers in Peridot, AZ

All providers in Peridot, AZ · Family Medicine Physician in Arizona

Sources for this page

Verify at the official NPI Registry.