Healthcare Provider Details

I. General information

NPI: 1336474592
Provider Name (Legal Business Name): MOJAVE FAMILY URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S HIGHWAY 95 STE A
FORT MOHAVE AZ
86426-9251
US

IV. Provider business mailing address

5300 S HIGHWAY 95 STE A
FORT MOHAVE AZ
86426-9251
US

V. Phone/Fax

Practice location:
  • Phone: 928-768-7175
  • Fax: 928-768-7247
Mailing address:
  • Phone: 928-768-7175
  • Fax: 928-768-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC4517
License Number StateAZ

VIII. Authorized Official

Name: DR. WILLIAM BRIAN WOMACK
Title or Position: OWNER
Credential: D.O.
Phone: 928-768-9496