Provider Demographics
NPI:1346346095
Name:NORTHERN ARIZONA VETERANS HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:NORTHERN ARIZONA VETERANS HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:928-776-6071
Mailing Address - Street 1:3618 W ANTHEM WAY STE D120
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0458
Mailing Address - Country:US
Mailing Address - Phone:623-551-6092
Mailing Address - Fax:
Practice Address - Street 1:3618 W ANTHEM WAY STE D120
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0458
Practice Address - Country:US
Practice Address - Phone:623-551-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3740282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital