Organization
PHC-FORT MOHAVE, INC.
Active
Other names
Crossroads Urgent Care by Valley View Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J. BIVACCA (PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
3641 HIGHWAY 95, BULLHEAD CITY, AZ 86442-8151
(928) 758-2273
(928) 758-2166
Mailing address
103 POWELL CT, BRENTWOOD, TN 37027-5079
(615) 372-8500
(615) 372-8572
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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