Healthcare Provider Details

I. General information

NPI: 1316267933
Provider Name (Legal Business Name): MD HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 LAKE HAVASU AVE S #A-11
LAKE HAVASU CITY AZ
86403-0851
US

IV. Provider business mailing address

1990 MCCULLOCH BLVD N D-215
LAKE HAVASU CITY AZ
86403-5749
US

V. Phone/Fax

Practice location:
  • Phone: 928-453-0506
  • Fax: 928-453-0508
Mailing address:
  • Phone: 702-227-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number37903
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number37903
License Number StateAZ

VIII. Authorized Official

Name: DR. ROBERT HAROLD INGHAM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 702-227-6947