Organization
ARIZONA INSTITURE OF MEDICINE & SURGERY
Active
Organization
ARIZONA INSTITURE OF MEDICINE & SURGERY
Active
Other names
Outpatien Treatment Ctr
Organization subpart
No
Provider details
NPI number
Authorized official
AZAM S KHAN (CHIEF ADMINISTRATIVE OFFICER)
(928) 757-3636
Entity
Organization
Contact information
Practice address
3636 STOCKTON HILL RD, KINGMAN, AZ 86409
(928) 757-3680
(928) 757-3614
Mailing address
3636 STOCKTON HILL RD, KINGMAN, AZ 86409-0514
(928) 757-3680
(928) 757-3614
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
OTC-0660
AZ
291U00000X
Clinical Medical Laboratory
Primary
03D0534286
AZ
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
OTC-0660
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167933
—
AZ
01
—
OTC-0660
MEDICAL FACILITY LICENSING
AZ
Enumeration date
11/20/2008
Last updated
06/04/2018
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