Havasu Medical Care

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

HAVASU MEDICAL CARE

Practice address

1955 McCulloch Blvd N
Lake Havasu City, AZ 86403-5748

Phone

(928) 453-3007

Fax

(928) 680-9663

NPI assigned

Oct 24, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Lou Callerame II, M.D.

Title

M.D.

Phone

(928) 453-3007

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258502400000",
    "number": "1033109863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1955 MCCULLOCH BLVD N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035748",
            "telephone_number": "928-453-3007",
            "fax_number": "928-680-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 MCCULLOCH BLVD N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035748",
            "telephone_number": "928-453-3007",
            "fax_number": "928-680-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU MEDICAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2009-11-18",
        "status": "A",
        "authorized_official_last_name": "CALLERAME",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LOU",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "928-453-3007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Havasu Emergency Physicians, PC
• Havasu Foot & Ankle Center
• Havasu Foot & Ankle Center
• Havasu Health Care Pharm
• Havasu Lung and Sleep Disorders Center LLC
• Havasu Medical Supply Inc.
• Havasu Neurological Center PLLC
• Havasu Nursing Center 2 Inc
• Havasu Physical Therapy
• Havasu Primary Care, LTD.

• General Practice Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• General Practice Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.