Provider Demographics
NPI:1336474592
Name:MOJAVE FAMILY URGENT CARE
Entity Type:Organization
Organization Name:MOJAVE FAMILY URGENT CARE
Other - Org Name:MOJAVE FAMILY HEALTHCARE AND URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-768-9496
Mailing Address - Street 1:5300 S HIGHWAY 95 STE A
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9251
Mailing Address - Country:US
Mailing Address - Phone:928-768-7175
Mailing Address - Fax:928-768-7247
Practice Address - Street 1:5300 S HIGHWAY 95 STE A
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-768-7175
Practice Address - Fax:928-768-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4517261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care