MEDICARE: LAKE HAVASU CITY

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
1	341600000X	Ambulance

General Provider Information

NPI Number	:	1710727086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE HAVASU CITY

Provider Business Mailing Address
First Line	:	2330 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5950
Country	:	US
Telephone Number	:	928-855-2116
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5950
Country	:	US
Telephone Number	:	928-855-2116
Fax Number	:

Authorized Official
Title or Position	:	CITY MANAGER
Name	:	JESS KNUDSON
Credential	:
Telephone Number	:	928-855-2116

Provider Enumeration Date	:	05/25/2024
Last Update Date	:	05/25/2024

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Directions to “LAKE HAVASU CITY ” Practice Location

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