Organization
SACRED MOUNTAIN MEDICAL SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANNY BARNEY (CEO)
(928) 283-8243
Entity
Organization
Contact information
Practice address
100 MOENAVE ROAD, #39, 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
05
—
830384848001
—
UT
01
—
AZ0152480
BLUE CROSS BLUE SHIELD
AZ
05
—
XMTEO6557
—
CA
Enumeration date
12/26/2008
Last updated
12/26/2008
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