1871596114 NPI number — NORTHERN ARIZONA SURGICENTER, LLC

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 1871596114 NPI number — NORTHERN ARIZONA SURGICENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ARIZONA SURGICENTER, LLC
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:
1871596114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 N SAN FRANCISCO ST
Provider Second Line Business Mailing Address:
# 100
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-3281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-774-3300
Provider Business Mailing Address Fax Number:
928-214-2137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 N SAN FRANCISCO ST
Provider Second Line Business Practice Location Address:
# 100
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-774-3300
Provider Business Practice Location Address Fax Number:
928-214-2137
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDON
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
928-214-2156

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  OSC-0083 , 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: AZ0204550 . This is a "BLUE CROSS BLUE SHIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 341040 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com