Provider Demographics
NPI:1538113808
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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NABILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-763-0433
Mailing Address - Street 1:3015 HIGHWAY 95
Mailing Address - Street 2:SUITE 107 B
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4334
Mailing Address - Country:US
Mailing Address - Phone:928-763-0433
Mailing Address - Fax:928-763-0839
Practice Address - Street 1:3015 HIGHWAY 95
Practice Address - Street 2:SUITE 107 B
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4334
Practice Address - Country:US
Practice Address - Phone:928-763-0433
Practice Address - Fax:928-763-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ746208Medicaid
AZ746208Medicaid
H78924Medicare UPIN