1316191471 NPI number — DYNAMIC INTERVENTIONS OF ARIZONA, LLC

Table of content: (NPI 1316191471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316191471 NPI number — DYNAMIC INTERVENTIONS OF ARIZONA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC INTERVENTIONS OF ARIZONA, LLC
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:
1316191471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2532 N 4TH ST # 481
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86004-3712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-226-1563
Provider Business Mailing Address Fax Number:
928-597-5180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4995 US HIGHWAY 68
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86413-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-707-2416
Provider Business Practice Location Address Fax Number:
928-597-5180
Provider Enumeration Date:
11/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
BOLAR
Authorized Official Title or Position:
CO-DIRECTOR
Authorized Official Telephone Number:
928-226-1563

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , 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)





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