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General NPI Number Information
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NPI Number | 1962529610
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Entity Type | Organization
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Legal Business Name | COCONINO COUNTY
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 2625 N KING ST CLINICAL SERVICES
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1884
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Country | US
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Telephone | 928-679-7222
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Fax | 928-679-7351
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Provider Business Mailing Address
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Address Line | 2625 N KING ST CLINICAL SERVICES
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1884
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Country | US
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Telephone | 928-679-7222
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Fax | 928-679-7351
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Authorized Official
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Title or Position | DIVISION MANAGER
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Name | SARAH SCHILDECKER
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Credential |
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Telephone | 928-679-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | AP1709
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License Number State | AZ
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