Organization
FORT MOJAVE INDIAN TRIBE
Active
Other names
FORT MOJAVE INDIAN HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM WILLIAMS (TRIBAL CHAIRPERSON)
(760) 629-4591
Entity
Organization
Contact information
Practice address
1607 PLANTATION RD, MOHAVE VALLEY, AZ 86440-9686
(928) 346-4679
(928) 346-4686
Mailing address
1607 PLANTATION RD, MOHAVE VALLEY, AZ 86440-9686
(928) 346-4679
(928) 346-4686
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500888779
CLIA
—
05
—
890211
—
AZ
01
—
EAP00010F
EAPC
CA
Enumeration date
05/16/2006
Last updated
02/06/2023
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