1538528955 NPI number — NORTHERN ARIZONA HEALTHCARE

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 1538528955 NPI number — NORTHERN ARIZONA HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ARIZONA HEALTHCARE
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:
1538528955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 FAIRWAY OAKS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDONA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86351-8839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6560 SR 179
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86351-7985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-282-8428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BARBER
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
928-282-8428

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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