Healthcare Provider Details

I. General information

NPI: 1942429477
Provider Name (Legal Business Name): MOHAVE EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 FLORENCE AVE
KINGMAN AZ
86401-4684
US

IV. Provider business mailing address

2610 E UNIVERSITY DR
MESA AZ
85213-8436
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-5454
  • Fax: 928-753-4283
Mailing address:
  • Phone: 480-892-8400
  • Fax: 480-892-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3C0001082
License Number StateAZ

VIII. Authorized Official

Name: KENNETH C WESTFIELD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 928-753-5454