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General NPI Number Information
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NPI Number | 1902065303
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Entity Type | Organization
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Legal Business Name | LAKE HAVASU RADIOLOGY, PLLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 1200 W MOHAVE RD
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City | PARKER
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State | AZ
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Zip | 85344-6349
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Country | US
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Telephone | 337-721-1961
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1766
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City | LAKE CHARLES
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State | LA
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Zip | 70602-1766
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Country | US
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Telephone | 337-721-1961
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Fax | 337-721-1939
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | VICKI CLOUD
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Credential |
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Telephone | 337-721-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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