Organization
UROLOLGY PROVIDERS OF NORTHERN ARIZONA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX M HORCHAK MD (PRESIDENT)
(928) 639-1311
Entity
Organization
Contact information
Practice address
450 S WILLARD ST, STE 105, COTTONWOOD, AZ 86326-6743
(928) 639-1311
(928) 639-1573
Mailing address
450 S WILLARD ST, STE 105, COTTONWOOD, AZ 86326-6743
(928) 639-1311
(928) 639-1573
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0420070
BCBS OF AZ
AZ
01
—
P00341295
RAILROAD MEDICARE
AZ
Enumeration date
01/25/2007
Last updated
08/22/2020
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