Fredonia Medical Center, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

08709408 Issued in AZ

Legal business name

FREDONIA MEDICAL CENTER, INC

Practice address

201 E Spring St
Kingman, AZ 86401-5844

Phone

(928) 715-4311

Fax

(928) 718-1986

NPI assigned

Oct 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kirsten Mortenson, D.O.

Title

Ceo

Phone

(928) 715-4311

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224633600000",
    "number": "1629220504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E SPRING ST",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864015844",
            "telephone_number": "928-715-4311",
            "fax_number": "928-718-1986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E SPRING ST",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864015844",
            "telephone_number": "928-715-4311",
            "fax_number": "928-718-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDONIA MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-22",
        "last_updated": "2008-10-22",
        "status": "A",
        "authorized_official_last_name": "MORTENSON",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-715-4311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "08709408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI NUMBER",
            "identifier": "1174517767",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "F05227",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eola Shelly Fowler
• Ruth Elaine Fowler, FNP/BC
• Bradley Fox, NP-C
• Ruth Anne Franco, NURSE PRACTITIONER
• Ethan Franzen, DO
• Rose Marie Freeman, REGISTERED NURSE
• Andrew Joseph French, PA-C
• Ronald Donnell French, M.A.
• Cindy Jane Frisby, LPN
• FSL Programs

• Primary Care Clinic/Center in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; 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.