MEDICARE: NORTHERN ARIZONA VETERANS HEALTH CARE SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	3740	AZ

General Provider Information

NPI Number	:	1346346095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN ARIZONA VETERANS HEALTH CARE SYSTEM

Provider Business Mailing Address
First Line	:	3618 W ANTHEM WAY STE D120
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0458
Country	:	US
Telephone Number	:	623-551-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 W ANTHEM WAY STE D120
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0458
Country	:	US
Telephone Number	:	623-551-6092
Fax Number	:

Authorized Official
Title or Position	:	STAFF PSYCHOLOGIST
Name	:	DR. GEOFFREY TIMOTHY HUTCHINSON
Credential	:	PH.D.
Telephone Number	:	928-776-6071

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	10/08/2009

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