1427385855 NPI number — NORTHERN ARIZONA PODIATRY GROUP

Table of content: (NPI 1427385855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427385855 NPI number — NORTHERN ARIZONA PODIATRY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ARIZONA PODIATRY GROUP
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:
1427385855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 N SWITZER CANYON DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-4852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-779-5111
Provider Business Mailing Address Fax Number:
928-779-1374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 N SWITZER CANYON DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-4852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-779-5111
Provider Business Practice Location Address Fax Number:
928-779-1374
Provider Enumeration Date:
11/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WYGAL
Authorized Official First Name:
MERLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
480-917-4974

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  0195 , 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)





Copyright © 2007-2025 www.npivalidator.com