Provider Demographics
NPI:1164104642
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 1:5130 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2837
Practice Address - Country:US
Practice Address - Phone:928-773-2054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN ARIZONA HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center