1538608716 NPI number — VERDE VALLEY MEDICAL CENTER

Table of content: (NPI 1538608716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538608716 NPI number — VERDE VALLEY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERDE VALLEY MEDICAL CENTER
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:
NORTHERN ARIZONA HEALTHCARE - SEDONA
Provider Other Organization Name Type Code:
3
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:
1538608716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N BEAVER ST
Provider Second Line Business Mailing Address:
ATTN: MANAGED CARE CONTRACTING
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-213-6543
Provider Business Mailing Address Fax Number:
928-214-3613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 W HIGHWAY 89A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86336-4937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-204-4100
Provider Business Practice Location Address Fax Number:
928-204-4115
Provider Enumeration Date:
02/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LOADER
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
928-773-2282

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H0122 , 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: 020438 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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