Organization Name: | MOJAVE FAMILY URGENT CARE |
NPI Number: | 1336474592 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM BRIAN WOMACK (OWNER) |
Mailing Address: | 5300 S Highway 95 Ste A Fort Mohave |
State: | AZ US |
Postal Code: | 864269251 |
Phone Number: | 9287687175 |
Fax Number: | 9287687247 |
NPI Enumeration Date: | 10/06/2009 |
NPI Last Update Date: | 10/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | OTC4517 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |