1942429477 NPI number — MOHAVE EYE SURGERY CENTER

Table of content: (NPI 1942429477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942429477 NPI number — MOHAVE EYE SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAVE EYE SURGERY CENTER
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:
1942429477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 E UNIVERSITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85213-8436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-892-8400
Provider Business Mailing Address Fax Number:
480-892-9533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 FLORENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86401-4684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-753-5454
Provider Business Practice Location Address Fax Number:
928-753-4283
Provider Enumeration Date:
04/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WESTFIELD
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
928-753-5454

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  3C0001082 , 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)