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General NPI Number Information
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NPI Number | 1063068898
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Entity Type | Organization
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Legal Business Name | AMBEST FAMILY HEALTH CLINICS, PLLC
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 4841 S MESA VILLAS DR APT 3
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-6436
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Country | US
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Telephone | 928-577-7368
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Fax | 928-299-3373
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Provider Business Mailing Address
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Address Line | 4325 S OTIS RD
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-6385
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Country | US
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Telephone | 770-688-6691
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Fax |
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Authorized Official
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Title or Position | OWNER / MEMBER MANAGER
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Name | OKEY ILOEGBUNAM
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Credential | NP
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Telephone | 770-688-6691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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