NPIMap

Organization Active NPI

Innovative Primary Care of Lake Havasu LLC

  • Primary Care Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1487314878
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
INNOVATIVE PRIMARY CARE OF LAKE HAVASU LLC
Practice address
1945 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5889
Phone
(928) 733-6287
Fax
(928) 733-6305
NPI assigned
Dec 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Authorized official

Name
Loida L Arquiza, NPNPI 1932732633
Title
Owner
Phone
(240) 535-0065

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1945 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5889

Mailing address

1945 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5889
Phone (928) 733-6287

Other names 1

  • Innovative Primary Care of Lake Havasu LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220126000461 AZ Part B Supplier - Clinic/Group Practice 3476945387 Receives reassigned benefits from 2 practitioners
Practice locations: Lake Havasu City, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1640563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640563200000",
    "number": "1487314878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035889",
            "telephone_number": "928-733-6287",
            "fax_number": "928-733-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035889",
            "telephone_number": "928-733-6287",
            "fax_number": "928-733-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PRIMARY CARE OF LAKE HAVASU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "ARQUIZA",
        "authorized_official_first_name": "LOIDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-535-0065",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Primary Care of Lake Havasu LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 27, 2021; 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.