Provider Demographics
NPI:1285703918
Name:FLAGSTAFF PRIMARY CARE, PC
Entity type:Organization
Organization Name:FLAGSTAFF PRIMARY CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-774-1811
Mailing Address - Street 1:1501 S YALE ST
Mailing Address - Street 2:STE #252
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7304
Mailing Address - Country:US
Mailing Address - Phone:928-774-1811
Mailing Address - Fax:928-774-2006
Practice Address - Street 1:1501 S YALE ST
Practice Address - Street 2:STE #252
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7304
Practice Address - Country:US
Practice Address - Phone:928-774-1811
Practice Address - Fax:928-774-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
AZ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ351282Medicaid