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Organization

DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM

Active
Parent organization
PHOENIX INDIAN MEDICAL CENTER
Other names
SHERMAN INDIAN SCHOOL CLINIC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PHOENIX INDIAN MEDICAL CENTER
Authorized official
LAURA A TILLMAN MD (CMO)
(602) 263-1674
Entity
Organization

Contact information

Practice address
9010 MAGNOLIA AVE, RIVERSIDE, CA 92503-4431
(951) 509-8914
(602) 200-5383
Mailing address
PO BOX 95460, CLEVELAND, OH 44101-0033
(602) 581-6088
(602) 263-1619

Taxonomy

Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary

Other

Enumeration date
08/22/2014
Last updated
05/26/2021
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