Organization
SACRED MOUNTAIN MEDICAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANNY BARNEY (OWNER)
(928) 283-8243
Entity
Organization
Contact information
Practice address
NP-39 MOENAVE RD/LOLMA ST, TUBA CITY, AZ 86045
(928) 283-8243
(928) 283-8237
Mailing address
PO BOX 2290, TUBA CITY, AZ 86045-2290
(928) 283-8243
(928) 283-8237
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
127
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02876271
—
MS
05
—
40953866
—
NM
05
—
717077
—
AZ
01
—
AZ0152480
BLUE CROSS BLUE SHIELD
AZ
05
—
XMTE06557
—
CA
Enumeration date
06/29/2006
Last updated
12/22/2008
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