Healthcare Provider Details

I. General information

NPI: 1003509688
Provider Name (Legal Business Name): NORTHERN ARIZONA HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 N US HIGHWAY 89 STE 270&280
FLAGSTAFF AZ
86004-6255
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: 928-522-8375
  • Fax:
Mailing address:
  • Phone: 928-213-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

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