Provider Demographics
NPI:1841354263
Name:SAN CARLOS APACHE TRIBE
Entity type:Organization
Organization Name:SAN CARLOS APACHE TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-475-4221
Mailing Address - Street 1:PO BOX 0
Mailing Address - Street 2:HWY 70 MOONBASE ROAD
Mailing Address - City:SAN CARLOS
Mailing Address - State:AZ
Mailing Address - Zip Code:85550-0000
Mailing Address - Country:US
Mailing Address - Phone:928-475-2798
Mailing Address - Fax:928-475-4009
Practice Address - Street 1:BLD 15 SAN CARLOS AVENUE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:AZ
Practice Address - Zip Code:85550
Practice Address - Country:US
Practice Address - Phone:928-475-4221
Practice Address - Fax:928-475-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071225Medicare PIN
AZ071225Medicaid