Provider Demographics
NPI:1477500155
Name:SEDONA FOOT & ANKLE SPECIALISTS P C
Entity Type:Organization
Organization Name:SEDONA FOOT & ANKLE SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SERJIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-282-3305
Mailing Address - Street 1:401 S CALVARY WAY
Mailing Address - Street 2:STE A
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4169
Mailing Address - Country:US
Mailing Address - Phone:928-282-3305
Mailing Address - Fax:928-282-6816
Practice Address - Street 1:401 S CALVARY WAY
Practice Address - Street 2:STE A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4169
Practice Address - Country:US
Practice Address - Phone:928-282-3305
Practice Address - Fax:928-282-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149262Medicaid
AZ0521550001Medicare NSC
AZZ69197Medicare PIN