Nathaniel Charles Hollister, MD
Individual provider Active NPI Emergency Medicine Physician · Fort Mohave, AZ
NPI 1104406586 · NPPES record last updated Jul 11, 2024
Key facts
- NPI
- 1104406586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 73509 (AZ)
- Practice address
- 5330 S Highway 95
Fort Mohave, AZ 86426-9225 - Phone
- (928) 788-2273
- NPI assigned
- Apr 10, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ, NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240708002036 | AZ | Practitioner - Emergency Medicine | 8123563715 | Reassigns benefits to 2 organizations |
| I20241017003588 | NV | Practitioner - Emergency Medicine | 8123563715 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73509 | AZ | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nes Arizona Inc | Emergency Medicine | Current |
Accepting new patients |
| Nes Arizona Inc | Emergency Medicine | Current |
Accepting new patients |
| Emergency Physicians Southwest, PC | Emergency Medicine | Current |
Accepting new patients |
| Shadow Emergency Physicians PLLC | Emergency Medicine | Current |
Accepting new patients |
| Shadow Emergency Physicians PLLC | Emergency Medicine | Current |
Accepting new patients |
Locations
450 S Ocotillo St
Benson, AZ 85602
Phone (520) 586-2261
5330 S Highway 95
Fort Mohave, AZ 86426
Phone (928) 788-2273
6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000
807 S Ponderosa St
Payson, AZ 85541
Phone (520) 474-3222
620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506
7300 State Highway 121
Ste 374
McKinney, TX 75070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 73509 | AZ | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
5330 S Highway 95
Fort Mohave, AZ 86426-9225
Mailing address
901 Rancho LN Ste 135
Las Vegas, NV 89106-3826
Phone (702) 383-7885
Other practice location 1
901 Rancho Ln Ste 135
Las Vegas, NV 89106-3826
Phone (702) 383-7885
Other providers in Fort Mohave, AZ
- Maria Elizabeth Harris
- Polly A Hediger
- Hematology Oncology Associates of North Jersey, LLC
- Richard E Hendrix
- Larry Coomer Hernandez
- Les Jay Holub
- Cari Dawn Horne
- HPH Homecare, LLC
- Han-Chin C Huang
- Deborah Ann Hughson
All providers in Fort Mohave, AZ · Emergency Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.