Provider Demographics
NPI:1275588659
Name:NORTHERN ARIZONA RADIOLOGY PC
Entity Type:Organization
Organization Name:NORTHERN ARIZONA RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-773-2515
Mailing Address - Street 1:DEPT 2018
Mailing Address - Street 2:PO BOX 29675
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-3340
Mailing Address - Country:US
Mailing Address - Phone:928-773-2515
Mailing Address - Fax:928-773-2240
Practice Address - Street 1:77 W FOREST AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1482
Practice Address - Country:US
Practice Address - Phone:928-773-2515
Practice Address - Fax:928-773-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0048350OtherBLUE CROSS BLUE SHIELD
UTZ1339Medicaid
AZZWCGJXMedicare PIN
AZZ72169Medicare PIN
CACS0809Medicare PIN