MEDICARE: PAINTED DESERT DEMONSTRATION PROJECT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	908600	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1922208099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAINTED DESERT DEMONSTRATION PROJECT

Provider Business Mailing Address
First Line	:	145 LEUPP RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-8501
Country	:	US
Telephone Number	:	602-412-3533
Fax Number	:	928-225-2179

Provider Business Practice Location Address
First Line	:	145 LEUPP RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-8501
Country	:	US
Telephone Number	:	602-412-3533
Fax Number	:	928-225-2179

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARK SORENSEN
Credential	:	ED.D
Telephone Number	:	602-412-3533

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

Similar Medicare Providers

1245379460 — MR. STEPHEN C. BABCOCK M.ED.
Practice Location Address:

145 LEUPP RD
FLAGSTAFF, AZ
86004-8501

Practice Phone: 602-412-3533
Practice Fax: 928-225-2179

1548696255 — MRS. JILL A DEDERA L.AC.
Practice Location Address:

3331 S MOORE CIR
FLAGSTAFF, AZ
86005-8501

Practice Phone: 928-699-6494
Practice Fax:

1063355378 — FAITH MULLENDER
Practice Location Address:

2631 E HEIDI LOOP
FLAGSTAFF, AZ
86004-1845

Practice Phone: 602-487-4730
Practice Fax:

1831192913 — KAREN HOLDER FNPC
Practice Location Address:

2920 N 4TH ST
FLAGSTAFF, AZ
86004-1816

Practice Phone: 928-213-6100
Practice Fax: 928-774-4808

1639179369 — DR. TERESA DENISE BERTSCH M.D.
Practice Location Address:

2920 N 4TH ST
FLAGSTAFF, AZ
86004-1816

Practice Phone: 928-522-9400
Practice Fax:

1841290806 — ALLIANCE MEDICAL LABORATORY, LLC
Practice Location Address:

1764 E ROUTE 66
FLAGSTAFF, AZ
86004-5139

Practice Phone: 928-773-2575
Practice Fax: 928-214-2680

Directions to “PAINTED DESERT DEMONSTRATION PROJECT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.