Provider Demographics
NPI:1780635078
Name:FLAGSTAFF MEDICAL CENTER
Entity Type:Organization
Organization Name:FLAGSTAFF MEDICAL CENTER
Other - Org Name:
Other - Org Type:
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: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:928-214-3613
Practice Address - Street 1:1200 N. BEAVER ST.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3118
Practice Address - Country:US
Practice Address - Phone:928-214-3631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0169282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0713800OtherDR INGABO BCBS
AZ020123Medicaid
AZ0000OtherCHAMPUS CHAMPVA
AZ901166OtherTUFTS
AZ037186OtherGROUP HEALTH PLAN
AZAZ0000190OtherBCBS ACUTE FMC
AZIZ0056OtherHEALTHNET
AZAZ0713800OtherDR INGABO BCBS
AZ020123Medicaid
AZAZ0000190OtherBCBS ACUTE FMC