1609010511 NPI number — MOHAVE COUNTY DEPT. OF PUBLIC HEALTH

Table of content: (NPI 1609010511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609010511 NPI number — MOHAVE COUNTY DEPT. OF PUBLIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAVE COUNTY DEPT. OF PUBLIC HEALTH
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:
Provider Other Organization Name Type Code:
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:
1609010511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 W BEALE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGMAN
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86401-5711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-753-0714
Provider Business Mailing Address Fax Number:
928-753-0775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2096 S HWY 389
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86021-6037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-753-8675
Provider Business Practice Location Address Fax Number:
928-875-8961
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PALMER
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
928-753-0748

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  OTC3466 , 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)





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