PHC-Fort Mohave Inc
Organization Active NPI General Acute Care Hospital · Fort Mohave, AZ
NPI 1811086994 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1811086994
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- H3864 (AZ)
- Legal business name
- PHC-FORT MOHAVE INC
- Practice address
- 5330 S Highway 95
Fort Mohave, AZ 86426-9225 - Phone
- (928) 788-2273
- Fax
- (928) 788-2273
- NPI assigned
- Oct 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 4
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 195
Practitioners 16
-
Juvy Escalante, PA
-
Adriana Hall, DO
-
Karla Marize Howard, NURSE PRACTITIONER
-
Daniel Itano, D.O.
-
Davinder Singh Mann, M.D.
-
Nanette S. Nuessle, M.D.
-
Caroline Chung Strecker, FNP-BC
-
Lawrence Young, MD
-
Darl Vilbro Bell, MD
-
Maureen Theresa Cadmus, MSN APN RN
-
Austin J Finklea, DO
-
Kinan Hawasly, M.D.
-
Faith Jepkemboi Sang, CNP
Affiliated clinicians 229
-
Nitish Aggarwal, MD/MBA
-
Mohamed S Ahmed, M.D.
-
Zane Ahmed, DO
-
Ricardo C Alfafara, M.D.
-
Nabila Aslam, M.D.
-
Natarajan Asokan, M.D.
-
Fadi Atassi, MD
-
Richard Lefroy Bailey, M.D.
-
Kayla Barnett, PA-C
-
Brent J Bedke, MD
-
Thomas Glenn Belt II, PA-C
-
Heidi A Berdin, MD
-
Rachel Lynn Blasingame, APRN, FNP-C
-
Scott Irwin Boggs, DPM
-
S Ismail Ah Bokhari Sr., M.D.
-
Peter Bostoros, MD
-
Clifford J Bragg, NP
Medicare Care Compare: Hospital
- Listed as
- Valley View Medical Center
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Hospital certification: CCN 030117
- Legal name
- PHC-FORT MOHAVE, INC.
- Doing business as
- VALLEY VIEW MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- May 17, 2006
- Last certification
- May 16, 2017
- Beds
- 84
- Ownership / control type
- Private (for profit)
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 11, 2002 in AZ
- Enrollment address
- 5330 S Highway 95
Fort Mohave, AZ 86426-9225 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Corporate Services General Partnership |
Operational/Managerial Control | Apr 15, 2005 | |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Province Healthcare Company LLC |
5% Or Greater Direct Ownership Interest | Apr 15, 2005 | 100% |
| Blake Hubbard |
Contracted Managing Employee |
Feb 12, 2024 | |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Marcus B Poppell |
Corporate Officer |
Apr 1, 2010 | |
| William Ziesmer |
Corporate Officer |
Feb 12, 2024 | |
| Charlotte E Lawrence |
Corporate Officer |
Apr 4, 2022 | |
| Elliott Brown |
Corporate Officer |
Apr 2, 2026 | |
| Russell a Bailey |
Corporate Officer |
Feb 2, 2026 | |
| Christopher J Monte |
Corporate Officer |
Jun 26, 2006 | |
| Legacy Lifepoint Health LLC |
5% Or Greater Indirect Ownership Interest | Apr 15, 2005 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050818001124 | AZ | Part a Provider - Hospital | 1557391547 | Practice locations: Bullhead City, AZ; Fort Mohave, AZ |
National Provider Directory
- Tax ID family
- PHC-Fort Mohave Inc
Interoperability endpoints
- valleyview@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | H3864 | AZ | Yes |
Addresses
Primary practice location
5330 S Highway 95
Fort Mohave, AZ 86426-9225
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| XHSP43833 | Medicaid | CA | |
| XHSP38333 | Medicaid | CA | |
| 104567 | Medicaid | AZ |
Other names
- Valley View Medical Center
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | valleyview@yourcarecommunity.org |
Other providers in Fort Mohave, AZ
- Shirley Pauline Peer
- PHC-Fort Mohave Inc
- PHC-Fort Mohave Inc
- PHC-Fort Mohave Inc
- PHC-Fort Mohave Inc
- PHC-Fort Mohave Inc
- PHC-Fort Mohave, Inc.
- Pinnacle Radiology Services
- Polar Star Medical
- Tanny Purugganan
All providers in Fort Mohave, AZ · General Acute Care Hospital in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.