# HUALAPAI MOUNTAIN MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962637710
- **Authorized official:** MR. DONALD J FENTEM (VP, REVENUE CYCLE MANAGEMENT)
- **Authorized official phone:** (972) 702-7500

## Contact information

- **Practice address:** 3801 SANTA ROSA, KINGMAN, AZ 86401-2311
- **Practice address phone:** (928) 757-2907
- **Practice address fax:** (928) 757-2931
- **Mailing address:** PO BOX 843719, DALLAS, TX 75284-3719
- **Mailing address phone:** (928) 757-2907
- **Mailing address fax:** (928) 757-2931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 05/22/2009
- **Last updated:** 01/24/2012