Provider Demographics
NPI:1861462608
Name:MARC H. ZIMMERMAN, M.D.P.C.
Entity Type:Organization
Organization Name:MARC H. ZIMMERMAN, M.D.P.C.
Other - Org Name:HAVASU ARTHRITIS & SPORTS MEDICINE INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-453-2663
Mailing Address - Street 1:1840 MESQUITE AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5771
Mailing Address - Country:US
Mailing Address - Phone:928-453-2663
Mailing Address - Fax:928-453-1452
Practice Address - Street 1:1840 MESQUITE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-453-2663
Practice Address - Fax:928-453-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14797207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ238552Medicaid
AZD37892Medicare UPIN
AZ83630Medicare ID - Type Unspecified