Provider Demographics
NPI: | 1093499303 |
---|---|
Name: | NORTHERN ARIZONA HEALTHCARE CORPORATION |
Entity Type: | Organization |
Organization Name: | NORTHERN ARIZONA HEALTHCARE CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CLIFFORD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LOADER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 928-773-2282 |
Mailing Address - Street 1: | 1200 N BEAVER ST |
Mailing Address - Street 2: | ATTN: MANAGED CARE CONTRACTING |
Mailing Address - City: | FLAGSTAFF |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 86001-3118 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-213-6543 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 107 E OAK AVE |
Practice Address - Street 2: | |
Practice Address - City: | FLAGSTAFF |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86001-1818 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-913-8800 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | NORTHERN ARIZONA HEALTHCARE CORPORATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-06-15 |
Last Update Date: | 2023-06-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |