Organization
FREDONIA MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIRSTEN MORTENSON D.O. (CEO)
(928) 715-4311
Entity
Organization
Contact information
Practice address
201 E SPRING ST, KINGMAN, AZ 86401-5844
(928) 715-4311
(928) 718-1986
Mailing address
201 E SPRING ST, KINGMAN, AZ 86401-5844
(928) 715-4311
(928) 718-1986
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
08709408
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174517767
PERSONAL NPI NUMBER
AZ
01
—
F05227
UPIN
AZ
Enumeration date
10/22/2008
Last updated
10/22/2008
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