Basic Information
| Provider Information | |||||||||
| NPI: | 1700240884 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BULLHEAD CITY CLINIC CORP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAUGHLIN WALK IN CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689022 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370689022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157788075 | ||||||||
| FaxNumber: | 6156286877 | ||||||||
| Practice Location | |||||||||
| Address1: | 1955 S CASINO DR | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | LAUGHLIN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890291560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022997203 | ||||||||
| FaxNumber: | 7022997212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2016 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | SWAW | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6157788076 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.