NPIMap

Organization Active NPI

Havasu Regional Medical Center LLC

  • Emergency Medicine Physician
  • Lake Havasu City, AZ
National Provider Identifier
1972825644
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
APPLIED FOR Issued in AZ
Legal business name
HAVASU REGIONAL MEDICAL CENTER LLC
Doing business as
HRMC Urgent Care Center
Practice address
1799 Kiowa Ave
# 104
Lake Havasu City, AZ 86403-2881
Phone
(928) 505-1030
NPI assigned
Feb 23, 2010
Organization subpart
Yes
Parent organization
HAVASU REGIONAL MEDICAL CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

Authorized official

Name
Terrance Dillon
Title
Assistant Secretary
Phone
(502) 596-7220

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X APPLIED FOR AZ Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X APPLIED FOR AZ
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X APPLIED FOR AZ
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X APPLIED FOR AZ

Addresses

Primary practice location

1799 Kiowa Ave
# 104
Lake Havasu City, AZ 86403-2881

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-4536
Phone (615) 920-7000

Other names 1

  • HRMC Urgent Care Center Doing business as

National Provider Directory

National Provider Directory
Part of
Havasu Regional Medical Center LLC

Locations

1799 Kiowa Ave
Ste 104
Lake Havasu City, AZ 86403
Phone (928) 505-1030

NPI Registry JSON

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1972825644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274536",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 KIOWA AVE",
            "address_2": "# 104",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864032881",
            "telephone_number": "928-505-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU REGIONAL MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVASU REGIONAL MEDICAL CENTER LLC",
        "enumeration_date": "2010-02-23",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "DILLON",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "502-596-7220"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "APPLIED FOR",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "APPLIED FOR",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "APPLIED FOR",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AZ",
            "license": "APPLIED FOR",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HRMC Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HRMC Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; 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.