Provider Demographics
NPI:1609010511
Name:MOHAVE COUNTY DEPT. OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:MOHAVE COUNTY DEPT. OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:928-753-0774
Mailing Address - Street 1:700 W BEALE ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5711
Mailing Address - Country:US
Mailing Address - Phone:928-753-0714
Mailing Address - Fax:928-753-0775
Practice Address - Street 1:20 SOUTH COLVIN
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:AZ
Practice Address - Zip Code:86021
Practice Address - Country:US
Practice Address - Phone:928-875-8960
Practice Address - Fax:928-875-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3466251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1740326727Medicare UPIN