Healthcare Provider Details

I. General information

NPI: 1598157745
Provider Name (Legal Business Name): FORT MOHAVE EMERGENCY MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 S HIGHWAY 95
FORT MOHAVE AZ
86426-9225
US

IV. Provider business mailing address

111 N SEPULVEDA BLVD SUITE 210
MANHATTAN BEACH CA
90266-6861
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-2273
  • Fax:
Mailing address:
  • Phone: 310-379-2134
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRV EDWARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-379-2134