Provider Demographics
NPI:1336341494
Name:NORTHWOODS MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NORTHWOODS MEDICAL ASSOCIATES, P.C.
Other - Org Name:RANDALL P SCOLL MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEEMA
Authorized Official - Middle Name:FOZIA
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-779-5707
Mailing Address - Street 1:930 N. SWITZER CANYON DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-779-5707
Mailing Address - Fax:928-779-5753
Practice Address - Street 1:930 N SWITZER CANYON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-779-5707
Practice Address - Fax:928-779-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE61567Medicare UPIN