Provider Demographics
NPI:1194369793
Name:WESTERN MOUNTAIN MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:WESTERN MOUNTAIN MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAGLIATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-763-0433
Mailing Address - Street 1:PO BOX 22018
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-2018
Mailing Address - Country:US
Mailing Address - Phone:928-763-0433
Mailing Address - Fax:928-763-0839
Practice Address - Street 1:2482 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2726
Practice Address - Country:US
Practice Address - Phone:702-906-1480
Practice Address - Fax:928-763-0839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MOUNTAIN MEDICAL CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-06
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care