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General NPI Number Information
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NPI Number | 1942429477
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Entity Type | Organization
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Legal Business Name | MOHAVE EYE SURGERY CENTER
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1919 FLORENCE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-4684
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Country | US
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Telephone | 928-753-5454
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Fax | 928-753-4283
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Provider Business Mailing Address
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Address Line | 2610 E UNIVERSITY DR
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City | MESA
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State | AZ
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Zip | 85213-8436
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Country | US
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Telephone | 480-892-8400
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Fax | 480-892-9533
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH C WESTFIELD
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Credential | M.D.
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Telephone | 928-753-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 3C0001082
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License Number State | AZ
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