Organization
GILA CROSSING CLINIC PHCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOREN ELLORY (CEO)
(602) 528-1200
Entity
Organization
Contact information
Practice address
9975 E BELTLINE RD, LAVEEN, AZ 85339
(602) 528-1422
(602) 528-3363
Mailing address
PO BOX 380, LAVEEN, AZ 85339-0380
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0326288
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
AHCCCS334582
—
AZ
Enumeration date
07/31/2006
Last updated
08/22/2020
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