Provider Demographics
NPI:1134382211
Name:TUBA CITY REGIONAL HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:TUBA CITY REGIONAL HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-2147
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2501
Mailing Address - Fax:928-283-2677
Practice Address - Street 1:HIGHWAY 89 NORTH AT THE 466 MILE MARKER
Practice Address - Street 2:1/8 MILE N OF CAMERON CHAPTER HOUSE
Practice Address - City:CAMERON
Practice Address - State:AZ
Practice Address - Zip Code:86020
Practice Address - Country:US
Practice Address - Phone:928-283-2672
Practice Address - Fax:928-283-2677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUBA CITY REGIONAL HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-08
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ409449Medicaid