NPIMap

Organization Active NPI

Innovative Health Care of Havasu LLC

  • Family Health Clinical Nurse Specialist
  • Lake Havasu City, AZ
National Provider Identifier
1114230893
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Health Clinical Nurse SpecialistTaxonomy code 364SF0001X
License
AP3726 Issued in AZ
Legal business name
INNOVATIVE HEALTH CARE OF HAVASU LLC
Practice address
297 Lake Havasu Ave South
Suite 200
Lake Havasu City, AZ 86403
Phone
(928) 854-7666
Fax
(928) 854-7660
NPI assigned
Jul 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2018

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

Authorized official

Name
Mrs. Summer Yvonne Tilgner, DNPNPI 1265745277
Title
Owner
Phone
(928) 854-7666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Health Clinical Nurse SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 364SF0001X AP3726 AZ Primary

Addresses

Primary practice location

297 Lake Havasu Ave South
Suite 200
Lake Havasu City, AZ 86403

Mailing address

297 Lake Havasu Ave South
Suite 200
Lake Havasu City, AZ 86403
Phone (928) 854-7666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100924001045 AZ Part B Supplier - Clinic/Group Practice 7416073622 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Havasu City, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1114230893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 LAKE HAVASU AVE SOUTH",
            "address_2": "SUITE 200",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-854-7666",
            "fax_number": "928-854-7660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 LAKE HAVASU AVE SOUTH",
            "address_2": "SUITE 200",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-854-7666",
            "fax_number": "928-854-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE HEALTH CARE OF HAVASU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-22",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "TILGNER",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-854-7666",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "AZ",
            "license": "AP3726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.