NPIMap

Organization Active NPI

Bullhead City Clinic Corp

  • Surgery Physician
  • Bullhead City, AZ
National Provider Identifier
1962429878
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4270 Issued in AZ
Legal business name
BULLHEAD CITY CLINIC CORP
Practice address
2500 Canyon Rd BLDG B
Bullhead City, AZ 86442-8624
Phone
(928) 763-9290
NPI assigned
Jul 16, 2006
Last updated
Jun 25, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BULLHEAD CITY CLINIC CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Authorized official

Name
Kristina Music
Title
Director of Provider Enrollment
Phone
(877) 892-9815

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Gastroenterology Physician 207RG0100X
Obstetrics & Gynecology Physician 207V00000X
Otolaryngology Physician 207Y00000X
Surgery Physician 208600000X 4270 AZ Primary
Urology Physician 208800000X

Addresses

Primary practice location

2500 Canyon Rd BLDG B
Bullhead City, AZ 86442-8624

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-3371

Other identifiers 1

IdentifierTypeStateIssuer
332390MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061005000614 AZ Part B Supplier - Clinic/Group Practice 1052317575 Receives reassigned benefits from 47 practitioners
Practice locations: Bullhead City, AZ; Fort Mohave, AZ; Bullhead, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D0940123Bullhead City Clinic Corporation2500 Canyon Rd BLDG B Ste 1-2, Bullhead City, AZ 86442Certificate of waiverFeb 4, 2028

National Provider Directory

National Provider Directory
Part of
Bullhead City Clinic Corp

Locations

2500 Canyon Rd
Ste B
Bullhead City, AZ 86442
Phone (928) 763-9290

2500 Canyon Rd
Ste B1
Bullhead City, AZ 86442
Phone (928) 444-1469

2500 Canyon Rd
Ste B2
Bullhead City, AZ 86442
Phone (928) 763-9290

2500 Canyon Rd
Ste C1
Bullhead City, AZ 86442
Phone (928) 444-1491

2724 Silver Creek Rd
Bullhead City, AZ 86442
Phone (928) 704-8904

2755 Silver Creek Rd
Ste 111
Bullhead City, AZ 86442
Phone (928) 704-6741

2755 Silver Creek Rd
Ste 217
Bullhead City, AZ 86442
Phone (928) 704-6070

2755 Silver Creek Rd
Ste A105
Bullhead City, AZ 86442
Phone (928) 704-6070

3735 Highway 95
Bullhead City, AZ 86442
Phone (702) 518-0137

3750 Highway 95
Ste 101
Bullhead City, AZ 86442
Phone (928) 763-1020

Practitioners & affiliated clinicians

Practitioners 85

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.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1962429878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 CANYON RD BLDG B",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864428624",
            "telephone_number": "928-763-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLHEAD CITY CLINIC CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BULLHEAD CITY CLINIC CORP",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "MUSIC",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9815"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "4270",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "332390",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bullhead City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.