Provider Demographics
NPI:1649615899
Name:LAKE HAVASU OB/GYN CARE LLC
Entity type:Organization
Organization Name:LAKE HAVASU OB/GYN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-302-5511
Mailing Address - Street 1:2130 MESQUITE AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6897
Mailing Address - Country:US
Mailing Address - Phone:928-302-5100
Mailing Address - Fax:928-302-5103
Practice Address - Street 1:2130 MESQUITE AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6897
Practice Address - Country:US
Practice Address - Phone:928-302-5100
Practice Address - Fax:928-302-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37930207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty