Provider Demographics
NPI:1518732023
Name:EXCEPTIONAL PHYSICIANS GROUP BULLHEAD CITY HOSPITAL PLLC
Entity Type:Organization
Organization Name:EXCEPTIONAL PHYSICIANS GROUP BULLHEAD CITY HOSPITAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHABANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-341-7800
Mailing Address - Street 1:3514 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4901
Mailing Address - Country:US
Mailing Address - Phone:469-341-7800
Mailing Address - Fax:469-341-7887
Practice Address - Street 1:2365 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6066
Practice Address - Country:US
Practice Address - Phone:928-224-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty