Healthcare Provider Details

I. General information

NPI: 1699702068
Provider Name (Legal Business Name): BARNET DULANEY SURGERY CENTER FLAGSTAFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4826
US

IV. Provider business mailing address

4800 N 22ND ST
PHOENIX AZ
85016-4701
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-1000
  • Fax: 602-508-4830
Mailing address:
  • Phone: 602-955-1000
  • Fax: 602-508-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number03C0001200
License Number StateAZ

VIII. Authorized Official

Name: DONALD SNYDER
Title or Position: CFO
Credential:
Phone: 602-955-1000