Individual
RUSSELL ROLISON MANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
59 PINE DEL ST, FLAGSTAFF, AZ 86001-9603
(928) 774-5669
Mailing address
59 PINE DEL ST, FLAGSTAFF, AZ 86001-9603
(928) 774-5669
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3807
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3807
AZDES PROVIDER FACILITY I
AZ
01
—
711714
AHCCCS
AZ
Enumeration date
11/06/2006
Last updated
07/08/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us