Provider Demographics
NPI: | 1679266290 |
---|---|
Name: | NORTHERN ARIZONA HEALTHCARE CORPORATION |
Entity Type: | Organization |
Organization Name: | NORTHERN ARIZONA HEALTHCARE CORPORATION |
Other - Org Name: | NORTHERN ARIZONA HEALTHCARE MEDICAL GROUP-CARDIOY & ENTIRE CARE WEST |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP-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: | |
Mailing Address - City: | FLAGSTAFF |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 86001-3118 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-213-6527 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2000 S THOMPSON ST |
Practice Address - Street 2: | |
Practice Address - City: | FLAGSTAFF |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86001-8759 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-226-6400 |
Practice Address - Fax: | 928-226-6411 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | NORTHERN ARIZONA HEALTHCARE CORPORATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-05-30 |
Last Update Date: | 2023-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207YS0012X | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |