Provider Demographics
NPI:1144938192
Name:NATIVE COUNTRY HEALTHCARE SYSTEMS
Entity type:Organization
Organization Name:NATIVE COUNTRY HEALTHCARE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:UGORJI
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:ONYEANI
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MD
Authorized Official - Phone:602-922-6182
Mailing Address - Street 1:1241 E BROADWAY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-2254
Mailing Address - Country:US
Mailing Address - Phone:847-766-9779
Mailing Address - Fax:
Practice Address - Street 1:4805 W THOMAS RD STE 14
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-4050
Practice Address - Country:US
Practice Address - Phone:847-766-9779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No283Q00000XHospitalsPsychiatric Hospital
No3336C0002XSuppliersPharmacyClinic Pharmacy
No341600000XTransportation ServicesAmbulance
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty