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General NPI Number Information
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NPI Number | 1538338058
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Entity Type | Organization
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Legal Business Name | FPS MEDICAL CENTER LTD
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 297 LAKE HAVASU AVE S STE 204
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6526
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Country | US
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Telephone | 928-453-1970
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Fax | 928-855-7229
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Provider Business Mailing Address
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Address Line | 297 LAKE HAVASU AVE S STE 204
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6526
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Country | US
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Telephone | 928-453-1970
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Fax | 928-855-7229
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KATIE PATRICK
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Credential |
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Telephone | 928-453-1970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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