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NPI Code Detail

MEDICARE: MOTT HAVEN MEDICAL CENTER INC

MEDICARE: MOTT HAVEN MEDICAL CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) Physician
2207R00000XInternal Medicine Physician
3208000000XPediatrics Physician
4261QM1300XMulti-Specialty Clinic/Center
5207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1194448498
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOTT HAVEN MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 2076 E PIEDMONT PL
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-6812
Country : US
Telephone Number : 716-400-9169
Fax Number :
Provider Business Practice Location Address
First Line : 2076 E PIEDMONT PL
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85122-6812
Country : US
Telephone Number : 716-400-9169
Fax Number :
Authorized Official
Title or Position : CEO
Name : ZACARIA OLIVERO
Credential :
Telephone Number : 716-400-9169
Provider Enumeration Date : 09/21/2022
Last Update Date : 09/21/2022

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Directions to “MOTT HAVEN MEDICAL CENTER INC ” Practice Location

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