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

Table of content: (NPI 1336341494)

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:
RANDALL P SCOLL MD PC
Provider Other Organization Name Type Code:
4
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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