Provider Demographics
NPI:1144492299
Name:NORTHERN ARIZONA PEDIATRIC INTENSIVE CARE SPECIALISTS
Entity type:Organization
Organization Name:NORTHERN ARIZONA PEDIATRIC INTENSIVE CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-214-3600
Mailing Address - Street 1:77 W FOREST AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1481
Mailing Address - Country:US
Mailing Address - Phone:928-214-3600
Mailing Address - Fax:928-214-3601
Practice Address - Street 1:77 W FOREST AVE STE 304
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1481
Practice Address - Country:US
Practice Address - Phone:928-214-3600
Practice Address - Fax:928-214-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty