Basic Information
| Provider Information | |||||||||
| NPI: | 1487007498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HRMC, LLC | ||||||||
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| OtherOrganizationName: | MOHAVE INFECTIOUS DISEASE & INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 MESQUITE AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | LAKE HAVASU CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864035771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9288541242 | ||||||||
| FaxNumber: | 9288541243 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 MESQUITE AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | LAKE HAVASU CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864035771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9288541242 | ||||||||
| FaxNumber: | 9288541243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2016 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | JUDY | ||||||||
| AuthorizedOfficialFirstName: | JESS | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP | ||||||||
| AuthorizedOfficialTelephone: | 9288541242 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 3173 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.