Healthcare Provider Details

I. General information

NPI: 1679461701
Provider Name (Legal Business Name): ALTACARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S WOODLANDS VILLAGE BLVD STE 700
FLAGSTAFF AZ
86001-2938
US

IV. Provider business mailing address

1200 N BEAVER ST ATTN MANAGED CARE CONTRACTING
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-440-5406
  • Fax:
Mailing address:
  • Phone: 928-213-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT COFIELD
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 928-773-2010