Provider Demographics
NPI:1033370119
Name:FOREST CANYON ENDOSCOPY &SURGERY CTR PC
Entity Type:Organization
Organization Name:FOREST CANYON ENDOSCOPY &SURGERY CTR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-774-3044
Mailing Address - Street 1:560 N SWITZER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4844
Mailing Address - Country:US
Mailing Address - Phone:928-774-3044
Mailing Address - Fax:928-774-7107
Practice Address - Street 1:560 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4844
Practice Address - Country:US
Practice Address - Phone:928-774-3044
Practice Address - Fax:928-774-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07653166J174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty