NPIMap

Organization Active NPI

Mohave Primary Care

  • Specialist
  • Kingman, AZ
National Provider Identifier
1700909330
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25797 Issued in AZ
Legal business name
MOHAVE PRIMARY CARE
Practice address
975 Sycamore Ave
Kingman, AZ 86409-3548
Phone
(928) 692-1900
Fax
(928) 692-7334
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ilangovan Govindarajan, M.D.,CMD
Title
President
Phone
(928) 692-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 25797 AZ Primary

Addresses

Primary practice location

975 Sycamore Ave
Kingman, AZ 86409-3548

Mailing address

2183 Seneca St
Kingman, AZ 86401-6511
Phone (928) 763-5948

National Provider Directory

National Provider Directory

Locations

975 Sycamore Ave
Kingman, AZ 86409
Phone (928) 692-1900

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700909330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2183 SENECA ST",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864016511",
            "telephone_number": "928-763-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 SYCAMORE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093548",
            "telephone_number": "928-692-1900",
            "fax_number": "928-692-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOVINDARAJAN",
        "authorized_official_first_name": "ILANGOVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-692-1900",
        "authorized_official_credential": "M.D.,CMD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "25797",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; 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.