Provider Demographics
NPI:1265541304
Name:MOHAVE SLEEP MEDICINE ASSOCIATES LLC
Entity type:Organization
Organization Name:MOHAVE SLEEP MEDICINE ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-763-5055
Mailing Address - Street 1:PO BOX 22666
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-2666
Mailing Address - Country:US
Mailing Address - Phone:928-763-5055
Mailing Address - Fax:928-763-5056
Practice Address - Street 1:1520 E HAMMER LN
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6664
Practice Address - Country:US
Practice Address - Phone:928-788-9445
Practice Address - Fax:928-763-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23706261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ112751Medicare PIN