# DHHS IHS PHOENIX AREA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** San Carlos Indian Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487906418
- **Authorized official:** MRS. SHIRLEY M BONI (ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (928) 475-7348

## Contact information

- **Practice address:** 223 CIBECUE CIRCLE ROAD, SAN CARLOS, AZ 85550-0208
- **Practice address phone:** (928) 475-7285
- **Mailing address:** PO BOX 208, SAN CARLOS, AZ 85550-0208
- **Mailing address phone:** (928) 475-7285
- **Mailing address fax:** (928) 475-7371

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/15/2012
- **Last updated:** 10/15/2012