NPIMap

Organization Active NPI

Havasu Primary Care, LTD.

  • Family Medicine Physician
  • Lake Havasu City, AZ
National Provider Identifier
1508169616
Registry record updated Dec 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43225 Issued in AZ
Legal business name
HAVASU PRIMARY CARE, LTD.
Practice address
1830 Mesquite Ave
Suite B
Lake Havasu City, AZ 86403-5885
Phone
(928) 453-0777
Fax
(928) 453-0778
NPI assigned
Dec 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2010

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

Authorized official

Name
Manu Lonial, M.D.
Title
President
Phone
(928) 453-0777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 43225 AZ Primary

Addresses

Primary practice location

1830 Mesquite Ave
Suite B
Lake Havasu City, AZ 86403-5885

Mailing address

PO Box 626
Lake Havasu City, AZ 86405-0626
Phone (928) 453-0777

Other identifiers 1

IdentifierTypeStateIssuer
16428743OtherAZCORPORATION REGISTRATION

National Provider Directory

National Provider Directory

Locations

1830 Mesquite Ave
Ste B
Lk Havasu Cty, AZ 86403
Phone (928) 453-0777

NPI Registry JSON

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

{
    "created_epoch": "1291939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1508169616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 626",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864050626",
            "telephone_number": "928-453-0777",
            "fax_number": "928-453-0778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 MESQUITE AVE",
            "address_2": "SUITE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035885",
            "telephone_number": "928-453-0777",
            "fax_number": "928-453-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU PRIMARY CARE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-10",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "LONIAL",
        "authorized_official_first_name": "MANU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-453-0777",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "43225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION REGISTRATION",
            "identifier": "16428743",
            "state": "AZ"
        }
    ],
    "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 Dec 10, 2010; 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.