| Willow Valley Medical Center Pc | |
|
8700 Highway 95 Mohave Valley AZ 86440-8519 | |
| (760) 217-2464 | |
| (928) 453-9207 |
| Full Name | Willow Valley Medical Center Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 8700 Highway 95, Mohave Valley, Arizona |
| Authorized Official Name and Position | Donovan J Anderson (PHYSICIAN) |
| Authorized Official Contact | 7602172464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Valley Medical Center Pc 8700 Highway 95 Mohave Valley AZ 86440-8519 Ph: (760) 217-2464 | Willow Valley Medical Center Pc 8700 Highway 95 Mohave Valley AZ 86440-8519 Ph: (760) 217-2464 |
| NPI Number | 1134111834 |
|---|---|
| Provider Enumeration Date | 08/18/2005 |
| Last Update Date | 02/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134111834 | NPI | - | NPPES |
| 205288-002 | Medicaid | AZ | |
| DI935A | Other | CA | MEDICARE PTAN |
| XPY055881 | Medicaid | CA | |
| 205288-01 | Medicaid | AZ | |
| AZ0325100 | Other | AZ | AZ BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 13491 (Arizona) | Primary |
Fort Mojave Indian Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1607 Plantation Rd, Mohave Valley, AZ 86440 Phone: 928-346-4679 Fax: 928-346-4686 | |
Tri-state Community Healthcare Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8700 S Highway 95, Mohave Valley, AZ 86440 Phone: 928-768-7113 |