| Organization Name: | PHOENIX INDIAN MEDICAL CENTER |
| NPI Number: | 1144382219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VELLIYAH ELLEN CRAIG (PHARMACIST) |
| Mailing Address: | 4212 N 16th St Phoenix |
| State: | AZ US |
| Postal Code: | 850165319 |
| Phone Number: | 6022964750 |
| Fax Number: | 6022631621 |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | RP00005927 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |