NPIMap

Organization Active NPI

Arizona Institute of Medicine and Surgery

  • Urgent Care Clinic/Center
  • Kingman, AZ
National Provider Identifier
1881680122
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
ARIZONA INSTITUTE OF MEDICINE AND SURGERY
Practice address
3636 Stockton Hill Road
Kingman, AZ 86409
Phone
(928) 757-3680
Fax
(928) 757-3614
NPI assigned
Sep 22, 2005
Last updated
Jun 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Authorized official

Name
Mr. Azam S. Khan
Title
Chief Administrative Officer
Phone
(928) 757-3636

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary
Clinical Medical Laboratory 291U00000X NU
Body Imaging Physician 2085B0100X OTC660 AZ
Diagnostic Radiology Physician 2085R0202X OTC660 AZ

Addresses

Primary practice location

3636 Stockton Hill Road
Kingman, AZ 86409

Mailing address

3636 Stockton Hill Road
Kingman, AZ 86409
Phone (928) 757-3680

Other identifiers 1

IdentifierTypeStateIssuer
167933MedicaidAZ

Other names 1

  • Outpatient Treatment Ctr Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000931 AZ Part B Supplier - Clinic/Group Practice 0547155566 Receives reassigned benefits from 4 practitioners
Practice locations: Kingman, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1881680122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 STOCKTON HILL ROAD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86409",
            "telephone_number": "928-757-3680",
            "fax_number": "928-757-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 STOCKTON HILL ROAD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86409",
            "telephone_number": "928-757-3680",
            "fax_number": "928-757-3614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA INSTITUTE OF MEDICINE AND SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "AZAM",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "928-757-3636",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "AZ",
            "license": "OTC660",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "OTC660",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167933",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Outpatient Treatment Ctr",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Outpatient Treatment Ctr",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 5, 2018; 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.