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General NPI Number Information
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NPI Number | 1306897962
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Entity Type | Organization
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Legal Business Name | FORT MOJAVE INDIAN TRIBE
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 1607 PLANTATION RD
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City | MOHAVE VALLEY
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State | AZ
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Zip | 86440-9686
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Country | US
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Telephone | 928-346-4679
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Fax | 928-346-4686
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Provider Business Mailing Address
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Address Line | 1607 PLANTATION RD
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City | MOHAVE VALLEY
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State | AZ
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Zip | 86440-9686
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Country | US
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Telephone | 928-346-4679
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Fax | 928-346-4686
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Authorized Official
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Title or Position | TRIBAL CHAIRPERSON
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Name | MR. TIM WILLIAMS
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Credential |
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Telephone | 760-629-4591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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