Provider Demographics
NPI:1114995271
Name:FLAGSTAFF SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:FLAGSTAFF SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-773-2222
Mailing Address - Street 1:PO BOX 31210
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-1210
Mailing Address - Country:US
Mailing Address - Phone:928-773-2222
Mailing Address - Fax:928-773-2598
Practice Address - Street 1:77 W FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
71005Medicare ID - Type Unspecified
AZZ71005Medicare PIN