Provider Demographics
NPI:1427234111
Name:FLAGSTAFF MEDICAL CENTER
Entity type:Organization
Organization Name:FLAGSTAFF MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-773-2010
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:ATTN: MANAGED CARE CONTRACTING
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6543
Mailing Address - Fax:928-214-3613
Practice Address - Street 1:1200 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3118
Practice Address - Country:US
Practice Address - Phone:928-779-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLAGSTAFF MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416A0800X
AZ3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ804311Medicaid
AZXMTA05923Medicaid
AZAZ0150860OtherCOMMERCIAL
AZ804311Medicaid
AZ000560831Medicaid
AZ003288069Medicaid
AZIZ6654OtherHEALTH NET MEDI CAL
AZN232835OtherHARMONY HEALTH
AZP0150860OtherBCBS SECONDARY
AZ030023Medicare PIN
AZXMTA05923Medicaid