Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM.
Active
Other names
Salt River Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LAURA A TILLMAN MD (CMO)
(602) 263-1674
Entity
Organization
Contact information
Practice address
10005 E OSBORN RD, SCOTTSDALE, AZ 85256-4019
(602) 263-1200
(602) 263-1618
Mailing address
PO BOX 95460, CLEVELAND, OH 44101-0033
(602) 581-6088
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092453
—
AZ
01
—
P0109880
BCBS
AZ
Enumeration date
07/26/2006
Last updated
05/26/2021
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