Healthcare Provider Details

I. General information

NPI: 1225158470
Provider Name (Legal Business Name): BULLHEAD URGENT CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RAMAR RD STE 11
BULLHEAD CITY AZ
86442-7100
US

IV. Provider business mailing address

1355 RAMAR RD STE 11
BULLHEAD CITY AZ
86442-7100
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-9202
  • Fax: 928-704-9207
Mailing address:
  • Phone: 928-704-9202
  • Fax: 928-704-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENISE L FAATZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-704-9202