Provider Demographics
NPI:1942291117
Name:MOHAVE NEURO REHAB CONSUL PC
Entity Type:Organization
Organization Name:MOHAVE NEURO REHAB CONSUL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-681-6600
Mailing Address - Street 1:1520 E HAMMER LN
Mailing Address - Street 2:STE 106
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6664
Mailing Address - Country:US
Mailing Address - Phone:928-681-6600
Mailing Address - Fax:928-681-6606
Practice Address - Street 1:1520 E HAMMER LN
Practice Address - Street 2:STE 106
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6664
Practice Address - Country:US
Practice Address - Phone:928-681-6600
Practice Address - Fax:928-681-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCE1180OtherRR MEDICARE
AZZ21066OtherMEDICARE PROV #