Provider Demographics
NPI:1245339811
Name:UROLOGY PROVIDERS OF NORTHERN ARIZONA
Entity type:Organization
Organization Name:UROLOGY PROVIDERS OF NORTHERN ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-639-1311
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6743
Mailing Address - Country:US
Mailing Address - Phone:928-639-1311
Mailing Address - Fax:928-639-1573
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-639-1311
Practice Address - Fax:928-639-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0329330OtherBCBS OF AZ
Z23614Medicare UPIN