NPIMap

Organization Active NPI

Northern Arizona General Surgical Group PC

  • Surgery Physician
  • Kingman, AZ
National Provider Identifier
1851469720
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
30616 Issued in AZ
Legal business name
NORTHERN ARIZONA GENERAL SURGICAL GROUP PC
Practice address
3880 Stockton Hill Rd
#103-128
Kingman, AZ 86409-0595
Phone
(928) 303-9593
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rodney Glen Courson, M.D.
Title
President
Phone
(928) 303-9593

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 30616 AZ Primary

Addresses

Primary practice location

3880 Stockton Hill Rd
#103-128
Kingman, AZ 86409-0595

Mailing address

3880 Stockton Hill Rd
#103-128
Kingman, AZ 86409-0595
Phone (928) 303-9593

Other identifiers 1

IdentifierTypeStateIssuer
726044MedicaidAZ

National Provider Directory

National Provider Directory

Locations

3880 N Stockton Hill Rd
#103128
Kingman, AZ 86409
Phone (928) 303-9593

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1851469720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 STOCKTON HILL RD",
            "address_2": "#103-128",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090595",
            "telephone_number": "928-303-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3880 STOCKTON HILL RD",
            "address_2": "#103-128",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090595",
            "telephone_number": "928-303-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ARIZONA GENERAL SURGICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "COURSON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-303-9593",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "AZ",
            "license": "30616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "726044",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.