Provider Demographics
NPI:1689719817
Name:HAVASU WOMEN'S HEALTH CENTER PC
Entity Type:Organization
Organization Name:HAVASU WOMEN'S HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-855-8176
Mailing Address - Street 1:1840 MESQUITE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5771
Mailing Address - Country:US
Mailing Address - Phone:928-855-8176
Mailing Address - Fax:928-855-1995
Practice Address - Street 1:1840 MESQUITE AVE STE H
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-855-8176
Practice Address - Fax:928-855-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14298174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0059940OtherBCBS AZ
AZ234154Medicaid
AZ26731Medicare ID - Type UnspecifiedFACILITY PROVIDER NUMBER
AZ0059940OtherBCBS AZ
AZ234154Medicaid