1336341494 NPI number — NORTHWOODS MEDICAL ASSOCIATES, P.C.

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 1336341494 NPI number — NORTHWOODS MEDICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWOODS MEDICAL ASSOCIATES, P.C.
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:
6
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:
1336341494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 N. SWITZER CANYON DRIVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-779-5707
Provider Business Mailing Address Fax Number:
928-779-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 N SWITZER CANYON DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-779-5707
Provider Business Practice Location Address Fax Number:
928-779-5753
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEAN
Authorized Official First Name:
SHEEMA
Authorized Official Middle Name:
FOZIA
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
928-779-5707

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  27944 , 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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