GILA RIVER HEALTH CARE CORPORATION (NPI# 1144359852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144359852 |
| Entity Type | Organization |
| Organization Name | GILA RIVER HEALTH CARE CORPORATION |
| Other Organization Name | KOMATKE PHARMACY |
| Practice Address |
17487 S Healthcare Dr Laveen AZ 85339-8500 |
| Practice Telephone | 5205506022 |
| Practice Fax Number | 5205506028 |
| Mailing Telephone | 5205506022 |
| Mailing Fax Number | 5205506028 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2017-04-28 |
| Authorized Official Name | LARRY CROLL (DIRECTOR, PHARMACY) |
| Authorized Official Telephone | 6025281200 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS334582 | 05 | |
| PK | 1991256 | 01 |
| Other Name | Type Code |
|---|---|
| KOMATKE PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568850329 | Gila River Health Care Corporation | Community Based Residential Treatment Facility, Mental Illness | 142226 S 53rd Ave, Laveen, AZ 85339 | 2015-01-02 |
| 1891776902 | Gila River Health Care Corporation | Clinic/Center | 565 W. Seed Farm Rd, Sacaton, AZ 85247 | 2005-11-07 |
| 1386633915 | Gila River Health Care Corporation | General Acute Care Hospital | 48203 W. Farrell Rd., Maricopa, AZ 85139-0038 | 2005-10-17 |
| 1376538231 | Gila River Health Care Corporation | General Acute Care Hospital | 17487 S. Health Care Dr., Laveen, AZ 85339-0038 | 2005-09-16 |
| 1629579230 | Gila River Health Care Corporation | Case Management | 3042 W. Queen Creek Road, Chandler, AZ 85286 | 2018-02-28 |
| 1821599424 | Gila River Health Care Corporation | Community/Behavioral Health | 3042 W. Queen Creek Road, Chandler, AZ 85286 | 2018-02-28 |
| 1437664182 | Gila River Health Care Corporation | General Acute Care Hospital | 3042 W. Queen Creek Road, Chandler, AZ 85286 | 2017-12-04 |
| 1114430147 | Gila River Health Care Corporation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 3042 W. Queen Creek Road, Chandler, AZ 85286 | 2017-11-13 |
| 1902189905 | Gila River Health Care Corporation | General Acute Care Hospital | 17487 S. Health Care Dr., Laveen, AZ 85339-0038 | 2011-09-26 |
| 1851600191 | Gila River Health Care Corporation | Community/Behavioral Health | 483 W. Seed Farm Road, Sacaton, AZ 85147-0001 | 2010-10-05 |
| Street Address |
17487 S HEALTHCARE DR |
| City | LAVEEN |
| State | AZ |
| Zip Code | 85339-8500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700439080 | Megan Zarina Ploss | Dentist | 17487 S Healthcare Dr, Laveen, AZ 85339-8500 | 2019-07-16 |
| 1437718194 | Han Hoac | Dentist | 17487 S Healthcare Dr, Laveen, AZ 85339-8500 | 2019-06-06 |
| 1386148021 | Joanne Ruelas | Social Worker | 17487 S Healthcare Dr, Laveen, AZ 85339-8500 | 2018-03-19 |
| 1427571926 | Brandon Merrill Ladd | Pharmacist | 17487 S Healthcare Dr, Laveen, AZ 85339-8500 | 2017-07-18 |
| 1023369303 | Erika M Caine | Pharmacist | 17487 S Healthcare Dr, Laveen, AZ 85339-8500 | 2012-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093351611 | Nationwide Vision Center, LLC | Technician/Technologist | 7650 S 59th Ave, Suite 101, Laveen, AZ 85339 | 2019-11-19 |
| 1164074282 | Alvis Lee Robertson | Counselor | 3850 N. 16th St. E. Beltline Rd., Laveen, AZ 85339 | 2019-07-09 |
| 1912493933 | Kristine Robles | Specialist/Technologist | 6501 W Alta Vista Rd, Laveen, AZ 85339 | 2018-07-02 |
| 1366968521 | Care Line, LLC | Home Health | 5818 West Pedro Lane, Laveen, AZ 85339 | 2017-08-19 |
| 1881119550 | Calvary Home Care Services Inc | Day Training, Developmentally Disabled Services | 4360 W. Alta Vista Rd, Laveen, AZ 85339 | 2017-08-03 |
| 1295284354 | Brian Hiapo Jr. | Assistant, Podiatric | 6170 S 51st Ave Ste 103, Laveen, AZ 85339 | 2016-09-29 |
| 1962850073 | Laveen Pediatric Dental Partners, LLP | Dentist | 5235 W. Baseline Rd, Ste 187, Laveen, AZ 85339 | 2016-05-31 |
| 1619353992 | Tiffany Lee | Specialist/Technologist | 7034 S. 64ave, Laveen, AZ 85339 | 2015-08-10 |
| 1558759068 | Makoto Wakamori | Counselor | 3850 North 16th Street Laveen Az 85339, Laveen, AZ 85339 | 2015-01-06 |
| 1568850329 | Gila River Health Care Corporation | Community Based Residential Treatment Facility, Mental Illness | 142226 S 53rd Ave, Laveen, AZ 85339 | 2015-01-02 |
| Find all providers in zip 85339 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841206257 | Gila Crossing Clinic Phcy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 9975 E Beltline Rd, Laveen, AZ 85339 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396244976 | Remgbekor | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 7227 S Central Ave Ste 1080, Phoenix, AZ 85042-5457 | 2018-02-08 |
| 1831448398 | Lechee Health Facility | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 3 Miles South of Page, Az, Coppermine Road, Lechee, AZ 86040-0000 | 2012-08-30 |
| 1467690966 | Medone Healthcare LLC | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2615 S Industrial Park Ave, Tempe, AZ 85282-1821 | 2009-01-22 |
| 1811165319 | Ton San Simon Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | West Hwy 86 Mile Marker 74, Sells, AZ 85634 | 2008-02-19 |
| 1659490225 | Tsaile Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Intersection Rt 64 and 12, Tsaile, AZ 86556 | 2007-03-28 |
| 1912030768 | Dhhs Phs Naihs Chinle Comprehensive Health Care Facility | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Nr 4 2 Mi East of Pinon, Pinon, AZ 86510 | 2007-03-13 |
| 1346377926 | Inscription House Hlth Ctr Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Hwy 98 and Navajo Rt 16, Shonto, AZ 86054 | 2007-02-28 |
| 1467587030 | Dhhs Ihs Phoenix Area | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2 West 3rd St, Cibecue, AZ 85911 | 2007-02-22 |
| 1023143609 | Dhhs Ihs Phoenix Area | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 238 Cibecue Circle, San Carlos, AZ 85550 | 2007-02-22 |
| 1376678946 | Dhhs Ihs Phoenix Area | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Hwy 264 Mile Marker 388, Polacca, AZ 86042 | 2007-02-22 |
| Find all providers with the same taxonomy | ||||
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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.