Healthcare Provider Details

I. General information

NPI: 1679566582
Provider Name (Legal Business Name): FOREST CANYON ENDOSCOPY & SURGERY CTR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4844
US

IV. Provider business mailing address

560 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4844
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-3044
  • Fax: 928-774-7107
Mailing address:
  • Phone: 928-774-3044
  • Fax: 928-774-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC3471
License Number StateAZ

VIII. Authorized Official

Name: TRICIA K FORDYCE
Title or Position: DIRECTOR
Credential:
Phone: 928-774-3044