Organization
AMBULATORY SURGI-CENTER AT FMC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN NOVAK (DIRECTOR)
(928) 214-2700
Entity
Organization
Contact information
Practice address
1200 N BEAVER ST STE B, FLAGSTAFF, AZ 86001-3118
(928) 214-2700
Mailing address
PO BOX 2730, FLAGSTAFF, AZ 86003-2730
(928) 214-2700
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC 2303
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157543
UHC
AZ
01
—
1Z7274
HEALTHNET
AZ
05
—
478364
—
AZ
01
—
AZ0205860
BCBS/AZ
AZ
Enumeration date
05/27/2006
Last updated
06/11/2010
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