Organization
MOHAVE NEURO REHAB CONSUL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J. PARKS MD (OWNER)
(928) 681-6600
Entity
Organization
Contact information
Practice address
1520 E HAMMER LN, STE 106, FORT MOHAVE, AZ 86426-6664
(928) 681-6600
(928) 681-6606
Mailing address
1520 E HAMMER LN, STE 106, FORT MOHAVE, AZ 86426-6664
(928) 681-6600
(928) 681-6606
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE1180
RR MEDICARE
AZ
01
—
Z21066
MEDICARE PROV #
AZ
Enumeration date
11/04/2005
Last updated
06/13/2008
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