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General NPI Number Information
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NPI Number | 1356099147
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Entity Type | Organization
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Legal Business Name | HOPCO FLAGSTAFF ASC HOLDINGS, LLC
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 1840 N JASPER DR. SUITE 1
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 623-537-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 24218 N 22ND ST STE 320
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City | PHOENIX
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State | AZ
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Zip | 85024-8693
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID JACOFSKY
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Credential | MD
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Telephone | 623-537-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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