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General NPI Number Information
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NPI Number | 1871596114
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Entity Type | Organization
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Legal Business Name | NORTHERN ARIZONA SURGICENTER, LLC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 1020 N SAN FRANCISCO ST # 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3281
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Country | US
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Telephone | 928-774-3300
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Fax | 928-214-2137
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Provider Business Mailing Address
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Address Line | 1020 N SAN FRANCISCO ST # 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3281
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Country | US
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Telephone | 928-774-3300
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Fax | 928-214-2137
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MRS. NORMA BRANDON
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Credential |
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Telephone | 928-214-2156
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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 | OSC-0083
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License Number State | AZ
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