Provider Demographics
NPI:1831127638
Name:HIDRK HEALTH CARE PC
Entity Type:Organization
Organization Name:HIDRK HEALTH CARE PC
Other - Org Name:WESTERN ARIZONA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAJAZ
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-444-1257
Mailing Address - Street 1:PO BOX 10169
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86427-0169
Mailing Address - Country:US
Mailing Address - Phone:928-444-1257
Mailing Address - Fax:928-444-1299
Practice Address - Street 1:967 HANCOCK RD
Practice Address - Street 2:SUITE 133
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5169
Practice Address - Country:US
Practice Address - Phone:928-444-1257
Practice Address - Fax:928-444-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ109174Medicare PIN