Healthcare Provider Details

I. General information

NPI: 1063377828
Provider Name (Legal Business Name): AZ NEURO SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 W UNIVERSITY AVE STE 130
FLAGSTAFF AZ
86001-7217
US

IV. Provider business mailing address

1254 W UNIVERSITY AVE STE 130
FLAGSTAFF AZ
86001-7217
US

V. Phone/Fax

Practice location:
  • Phone: 928-395-3296
  • Fax: 928-395-4007
Mailing address:
  • Phone: 928-395-3296
  • Fax: 928-395-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GEIS
Title or Position: BILLING MANAGER
Credential:
Phone: 800-407-1744