Organization
AZ BD OF REGENTS FOR ON BEHALF OF NORTHERN AZ UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D HAEGER PHD LCSW LCAS RN (PRESIDENT)
(928) 523-6343
Entity
Organization
Contact information
Practice address
824 S SAN FRANCISCO ST, BLDG 25 NORTHERN ARIZONA UNIVERSITY CAMPUS, FLAGSTAFF, AZ 86011-0001
(928) 523-6343
(928) 523-5730
Mailing address
PO BOX 6033, FLAGSTAFF, AZ 86011-6033
(928) 523-6343
(928) 523-5730
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
OTC5149
AZ
261QR0200X
Radiology Clinic/Center
3E115
AZ
261QS1000X
Student Health Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
03D0057902
AZ
3336C0003X
Community/Retail Pharmacy
Y005336
AZ
Other
Enumeration date
07/07/2006
Last updated
08/15/2011
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