Basic Information
| Provider Information | |||||||||
| NPI: | 1164495503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN ARIZONA ORTHOPAEDICS, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 N TURQUOISE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747757 | ||||||||
| FaxNumber: | 9287747767 | ||||||||
| Practice Location | |||||||||
| Address1: | 1485 N TURQUOISE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747757 | ||||||||
| FaxNumber: | 9287747767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MUELLER | ||||||||
| AuthorizedOfficialFirstName: | VERONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE & REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 9282143233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 0706750001 | 01 | AZ | DMERC | OTHER |