MEDICARE: MOHAVE MEDICAL IMAGING CENTER

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1770504870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAVE MEDICAL IMAGING CENTER

Provider Business Mailing Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 112
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-505-4661
Fax Number	:	928-505-4699

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 112
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-505-4661
Fax Number	:	928-505-4699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAADEH SAADEH
Credential	:	MD
Telephone Number	:	928-505-4661

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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Directions to “MOHAVE MEDICAL IMAGING CENTER ” Practice Location

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