Provider Demographics
NPI:1669641387
Name:MOHAVE CENTRE FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:MOHAVE CENTRE FOR PLASTIC SURGERY
Other - Org Name:MCPS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-854-5400
Mailing Address - Street 1:2010 INJO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5707
Mailing Address - Country:US
Mailing Address - Phone:928-854-5400
Mailing Address - Fax:928-854-5401
Practice Address - Street 1:2010 INJO DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5707
Practice Address - Country:US
Practice Address - Phone:928-854-5400
Practice Address - Fax:928-854-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty