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5130 Hwy 95, Fort Mohave, AZ 86426-9374 | |
(928) 768-2811 | |
(928) 768-9787 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Multi-specialty |
Location | 5130 Hwy 95, Fort Mohave, Arizona |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1598092082 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 7353 (Arizona) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Terry L Coyle |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639127780 PECOS PAC ID: 6901863349 Enrollment ID: I20131125001367 |
Provider Name | Allen E Stout |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902833817 PECOS PAC ID: 0042245904 Enrollment ID: I20191213001298 |
Mailing Address | Practice Location Address |
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5130 Hwy 95, Fort Mohave, AZ 86426-9374 Ph: (928) 768-2811 | 5130 Hwy 95, Fort Mohave, AZ 86426-9374 Ph: (928) 768-2811 |