Provider Demographics
NPI:1871531418
Name:PLASTIC SURGEONS OF NORTHERN ARIZONA, PLLC
Entity type:Organization
Organization Name:PLASTIC SURGEONS OF NORTHERN ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-774-2300
Mailing Address - Street 1:1020 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3281
Mailing Address - Country:US
Mailing Address - Phone:928-774-2300
Mailing Address - Fax:928-214-2137
Practice Address - Street 1:1020 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3281
Practice Address - Country:US
Practice Address - Phone:928-774-2300
Practice Address - Fax:928-214-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07447612F174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCLHNMedicare ID - Type UnspecifiedMEDICARE NUMBER