Provider Demographics
NPI:1336433051
Name:ASHMEAD ALI
Entity Type:Organization
Organization Name:ASHMEAD ALI
Other - Org Name:MOJAVE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASHMEAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-824-2729
Mailing Address - Street 1:16914 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:MOJAVE
Mailing Address - State:CA
Mailing Address - Zip Code:93501-1226
Mailing Address - Country:US
Mailing Address - Phone:661-824-2729
Mailing Address - Fax:661-430-5448
Practice Address - Street 1:16914 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1226
Practice Address - Country:US
Practice Address - Phone:661-824-2729
Practice Address - Fax:661-430-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78625261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG78625OtherLIC NUMBER
CA553894Medicare PIN
CAG06444Medicare UPIN