Organization
DHHS, PHS, NAIHS, SHIPROCK HOSPITAL
Active
Other names
Four Corners Regional Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
FANNESSA COMER (CEO)
(505) 368-6005
Entity
Organization
Contact information
Practice address
US HWY 160 & NAVAJO ROUTE 35 - RED MESA, TEECNOSPOS, AZ 86514
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QD0000X
Dental Clinic/Center
—
—
261QE0002X
Emergency Care Clinic/Center
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP1100X
Podiatric Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282586
—
AZ
05
—
37256718
—
CO
05
—
61109321
—
NM
05
—
7000000084
—
UT
05
—
7000000092
—
UT
Enumeration date
12/14/2006
Last updated
01/07/2011
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