Organization
HAVASU FOOT & ANKLE CENTER
Active
Other names
Havasu Foot & Ankle Surgicenter
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA NOVACK RN (OFFICE MANAGER)
(928) 855-7800
Entity
Organization
Contact information
Practice address
90 RIVIERA DR, LAKE HAVASU CITY, AZ 86403-5716
(928) 855-7800
(928) 855-5392
Mailing address
90 RIVIERA DR, LAKE HAVASU CITY, AZ 86403-5716
(928) 855-7800
(928) 855-5392
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490002545
METRAHEALTH MEDICARE RR
—
Enumeration date
03/21/2006
Last updated
06/17/2008
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