SACRED MOUNTAIN MEDICAL SERVICE (NPI# 1871739755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871739755 |
| Entity Type | Organization |
| Organization Name | SACRED MOUNTAIN MEDICAL SERVICE |
| Practice Address |
100 Moenave Road #39 Tuba City AZ 86045 |
| Mailing Address |
Po Box 2290 Tuba City AZ 86045-2290 |
| Practice Telephone | 9282838243 |
| Practice Fax Number | 9282838237 |
| Mailing Telephone | 9282838243 |
| Mailing Fax Number | 9282838237 |
| Enumeration Date | 2008-12-26 |
| Last Update Date | 2008-12-26 |
| Authorized Official Name | MR. DANNY BARNEY (CEO) |
| Authorized Official Telephone | 9282838243 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3416L0300X |
Ambulance Specialization: Land Transport |
127 | AZ | Transportation Services |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 40953866 | 05 | |
| CA | XMTEO6557 | 05 | |
| UT | 830384848001 | 05 | |
| MS | 02876271 | 05 | |
| AZ | 717077 | 05 | |
| AZ | BLUE CROSS BLUE SHIELD | AZ0152480 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SACRED MOUNTAIN MEDICAL SERVICES, INC. | 346 South Peshlakai Ave, Tuba City, AZ 86045 |
| Street Address |
100 MOENAVE ROAD #39 |
| City | TUBA CITY |
| State | AZ |
| Zip Code | 86045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851559249 | Sacred Mountain Transport Inc | Non-emergency Medical Transport (VAN) | 100 Moenave Road, Space 39, Tuba City, AZ 86045 | 2008-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434206 | Ambrielle Grace Begay | Specialist/Technologist | 48 Turquoise Drive, Tuba City, AZ 86045 | 2020-10-12 |
| 1063028124 | Fresenius Medical Care Tuba City, LLC | Clinic/Center | 50 S. Main Street, Ste 108, Tuba City, AZ 86045 | 2020-09-23 |
| 1609422484 | Rebekah Lee | Pharmacist | 167 North Main St. Tuba City Regional Health Care Corp., Tuba City, AZ 86045 | 2019-08-16 |
| 1861977050 | Kyle C Nguyen | Pharmacist | 3008 E. Birch Ave, Tuba City, AZ 86045 | 2018-10-03 |
| 1518419845 | John Glenn Ives | Pharmacist | 167 N, Main St, Tuba City, AZ 86045 | 2016-11-03 |
| 1497208433 | Toweringrock Non-emergency Medical Transport, LLC | Non-emergency Medical Transport (VAN) | 1029 E. Tc North Side Trailer, 36.153821-111.233925, Tuba City, AZ 86045 | 2016-07-26 |
| 1699153270 | Hopi Assisted Living Facility Inc. | Point of Service | 21 Senior Lane Upper Hud Housing Moenkopi, Hopi Assisted Living, Tuba City, AZ 86045 | 2015-05-14 |
| 1306223870 | Mia Seimy | Driver | Adair Avenue Space #5, Tuba City, AZ 86045 | 2015-05-04 |
| 1033507587 | Tari Carroll | Home Health Aide | Tumbleweed Drive Nha E-3, Tuba City, AZ 86045 | 2015-01-07 |
| 1023452984 | Amanda Bancroft Burrage | Pediatrics | 167 Main St., Tuba City, AZ 86045 | 2013-04-23 |
| Find all providers in zip 86045 | ||||
| Taxonomy Code | 3416L0300X |
| Grouping | Transportation Services |
| Classification | Ambulance |
| Specialization | Land Transport |
| Definition to come... |
| Notes: [1/1/2005: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447288436 | Sacred Mountain Medical Services Inc | Ambulance | Np-39 Moenave Rd/lolma St, Tuba City, AZ 86045 | 2006-06-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.