NPIMap

Organization Active NPI

Mohave Medical Oncology Center

  • Hematology & Oncology Physician
  • Kingman, AZ
National Provider Identifier
1386834844
Registry record updated Jan 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD18958 Issued in AZ
Legal business name
MOHAVE MEDICAL ONCOLOGY CENTER
Practice address
3801 Santa Rosa
Suite 200
Kingman, AZ 86401-2311
Phone
(702) 471-7779
Fax
(702) 471-0484
NPI assigned
Jul 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2012

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

Authorized official

Name
Julie Linn Konie
Title
Practice Manager
Phone
(702) 471-7779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0003X MD18958 AZ Primary

Addresses

Primary practice location

3801 Santa Rosa
Suite 200
Kingman, AZ 86401-2311

Mailing address

PO Box 777550
Henderson, NV 89077-7550
Phone (702) 471-7779

Other identifiers 1

IdentifierTypeStateIssuer
056037MedicaidAZ

National Provider Directory

National Provider Directory

Locations

3801 Santa Rosa Dr
#B
Kingman, AZ 86401
Phone (520) 753-9499

Practitioners & affiliated clinicians

Practitioners 7

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": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327968000000",
    "number": "1386834844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 777550",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890777550",
            "telephone_number": "702-471-7779",
            "fax_number": "702-471-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 SANTA ROSA",
            "address_2": "SUITE 200",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864012311",
            "telephone_number": "702-471-7779",
            "fax_number": "702-471-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE MEDICAL ONCOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2012-01-31",
        "status": "A",
        "authorized_official_last_name": "KONIE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "LINN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "702-471-7779"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AZ",
            "license": "MD18958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056037",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2012; 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.