NPI 1497299101

Lifestyles

Organisation Exclusive Provider Organization Flagstaff, AZ

Practice location

Address: 4385 E Wild Elk Trl, Flagstaff, AZ 86004-7921
Phone: (928) 326-0044

Authorised official

Name: Dwight C Boyd
Title: Ceo
Phone: (928) 326-0044

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Arizona →

Registry record

NPI: 1497299101
Entity type: Organization
NPI issued: 14 Dec 2016
Record last updated: 14 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.