Organization
COLORADO RIVER PRIMARY CARE, INC
Active
Other names
Tri State Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
WANTZY COOPER DO (PRESIDENT)
(928) 248-0518
Entity
Organization
Contact information
Practice address
1510 E WAGON WHEEL LN STE 104, FORT MOHAVE, AZ 86426-6698
(928) 248-0518
(928) 514-2823
Mailing address
1510 E WAGON WHEEL LN STE 104, FORT MOHAVE, AZ 86426-6698
(928) 248-0518
(928) 514-2823
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
08/04/2021
Last updated
03/04/2024
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