Healthcare Provider Details

I. General information

NPI: 1235732702
Provider Name (Legal Business Name): NORTHERN ARIZONA HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 N US HIGHWAY 89
FLAGSTAFF AZ
86004-2837
US

IV. Provider business mailing address

1200 N. BEAVER STREET ATTN: MANGED CARE CONTRACTING
FLAGSTAFF AZ
86001
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2054
  • Fax: 928-773-2286
Mailing address:
  • Phone: 928-213-6543
  • Fax: 928-214-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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