Organization
DHHS IHS PHOENIX AREA
Active
Other names
San Carlos Indian Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY M BONI (ADMINISTRATIVE OFFICER)
(928) 475-7348
Entity
Organization
Contact information
Practice address
223 CIBECUE CIRCLE ROAD, SAN CARLOS, AZ 85550-0208
(928) 475-7285
Mailing address
PO BOX 208, SAN CARLOS, AZ 85550-0208
(928) 475-7285
(928) 475-7371
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
152W00000X
Optometrist
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
10/15/2012
Last updated
10/15/2012
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