1295059889 NPI number — FAMILY HEALTH PC

Table of content: (NPI 1295059889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295059889 NPI number — FAMILY HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAYES CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295059889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2354 S CORDES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86413-8774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-565-7976
Provider Business Mailing Address Fax Number:
938-565-7176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1734 HIGHWAY 95 STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-6999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-234-2264
Provider Business Practice Location Address Fax Number:
928-565-7176
Provider Enumeration Date:
03/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
BART
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
928-565-7076

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7365 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)