Organization
BULLHEAD CITY CLINIC CORP
Active
Parent organization
BULLHEAD CITY CLINIC CORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BULLHEAD CITY CLINIC CORP
Authorized official
KRISTINA MUSIC (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
2500 CANYON RD BLDG B, BULLHEAD CITY, AZ 86442-8624
(928) 763-9290
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-3371
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
Primary
4270
AZ
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332390
—
AZ
Enumeration date
07/16/2006
Last updated
06/25/2025
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