1164495503 NPI number — NORTHERN ARIZONA ORTHOPAEDICS, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164495503 NPI number — NORTHERN ARIZONA ORTHOPAEDICS, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ARIZONA ORTHOPAEDICS, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164495503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1485 N TURQUOISE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-1398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-774-7757
Provider Business Mailing Address Fax Number:
928-774-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1485 N TURQUOISE DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-1398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-774-7757
Provider Business Practice Location Address Fax Number:
928-774-7767
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUELLER
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE & REIMBURSEMENT
Authorized Official Telephone Number:
928-214-3233

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0706750001 . This is a "DMERC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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