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Kaibeto Boarding School Dorm # 4 Kaibeto AZ 86053-2121 | |
| (928) 673-3491 | |
| (928) 673-3494 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | Kaibeto Boarding School Dorm # 4, Kaibeto, Arizona |
| Authorized Official Name and Position | Elizabeth G Latham (CEO) |
| Authorized Official Contact | 9286459675 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1625 Page AZ 86040-1625 Ph: (928) 645-9675 | Kaibeto Boarding School Dorm # 4 Kaibeto AZ 86053-2121 Ph: (928) 673-3491 |
| NPI Number | 1568430676 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568430676 | NPI | - | NPPES |
| 432857 | Medicaid | AZ | |
| 594045 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |