PANACEA BRAIN AND SPINE, LLC (NPI# 1154765121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154765121 |
| Entity Type | Organization |
| Organization Name | PANACEA BRAIN AND SPINE, LLC |
| Practice Address |
297 Lake Havasu Ave S Suite 204 Lake Havasu City AZ 86403-6526 |
| Mailing Address |
2980 N Beverly Glen Cir Suite 301 Los Angeles CA 90077-1726 |
| Practice Telephone | 9284532211 |
| Mailing Telephone | 3104749809 |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2013-04-22 |
| Authorized Official Name | DR. CHAD E. HARTLEY (OWNER) |
| Authorized Official Telephone | 9284532211 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PANACEA BRAIN AND SPINE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457622763 | Panacea Brain and Spine, LLC | Neurological Surgery | 72 Lake Havasu Ave S Ste 102, Lake Havasu City, AZ 86403-0857 | 2012-01-18 |
| Street Address |
297 LAKE HAVASU AVE S SUITE 204 |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-6526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124011390 | June Franzen | Nurse Practitioner | 297 Lake Havasu Ave S, Suite 200, Lake Havasu City, AZ 86403-6526 | 2005-08-23 |
| 1992136873 | Innovative Womens Health Care of Havasu Pllc | Nurse Practitioner | 297 Lake Havasu Ave S, Suite 106, Lake Havasu City, AZ 86403-6526 | 2013-12-03 |
| 1265862676 | Innovative Health and Wellness Center | Registered Nurse | 297 Lake Havasu Ave S, 200, Lake Havasu City, AZ 86403-6526 | 2013-11-21 |
| 1063849388 | Havasu Neurological Center Pllc | Psychiatry & Neurology | 297 Lake Havasu Ave S, Suite 106, Lake Havasu City, AZ 86403-6526 | 2013-10-01 |
| 1588097349 | Innovative Primary Care Clinic of Havasu Pllc | Nurse Practitioner | 297 Lake Havasu Ave S, Suite 106, Lake Havasu City, AZ 86403-6526 | 2013-08-15 |
| 1356695431 | Desert Mountain Orthopaedics & Sports Medicine LLC | Orthopaedic Surgery | 297 Lake Havasu Ave S, Suite 108, Lake Havasu City, AZ 86403-6526 | 2012-10-29 |
| 1962660134 | Maame Ampomah Dankwah-quansah | Psychiatry & Neurology | 297 Lake Havasu Ave S, Suite 106, Lake Havasu City, AZ 86403-6526 | 2008-05-23 |
| 1124202726 | E Franklin Livingstone Md PC | Physical Medicine & Rehabilitation | 297 Lake Havasu Ave S, Ste 106, Lake Havasu City, AZ 86403-6526 | 2007-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609375740 | Cerner Health Connections, Inc | Non-Pharmacy Dispensing Site | 89 Civic Center Ln, Lake Havasu City, AZ 86403-0810 | 2018-02-05 |
| 1164542353 | Focus Optical, LLC | Non-Pharmacy Dispensing Site | 1987 Mcculloch Blvd N, Suite #108, Lake Havasu City, AZ 86403-5770 | 2007-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518318328 | John C Lincoln, LLC | Non-Pharmacy Dispensing Site | 6220 W Bell Rd, Suite 100, Glendale, AZ 85308-3718 | 2016-06-23 |
| 1992178982 | Caremore Health Plan of Arizona Inc | Non-Pharmacy Dispensing Site | 315 W Irvington Rd, Ste.101, Tucson, AZ 85714-3151 | 2015-11-12 |
| 1558747725 | Arizona Oncology Associates, PC | Non-Pharmacy Dispensing Site | 3188 N Windsong Dr # Sr, Ste. # A, Prescott Valley, AZ 86314-1220 | 2015-08-10 |
| 1578976379 | Arizona Oncology Associates PC | Non-Pharmacy Dispensing Site | 1315 S La Canada Dr, Green Valley, AZ 85622-1915 | 2014-06-09 |
| 1023302643 | Tri-state Medical Specialists LLC | Non-Pharmacy Dispensing Site | 1510 Wagon Wheel Lane, Suite 110, Fort Mohave, AZ 86426-6698 | 2011-05-31 |
| 1396066395 | Wound Care Usa, LLC | Non-Pharmacy Dispensing Site | 3959 E Speedway Blvd, Suite 316, Tucson, AZ 85712-4553 | 2010-06-14 |
| 1417112541 | Gold Canyon Internal Medicine | Non-Pharmacy Dispensing Site | 6724 S Kings Ranch Rd Ste 102, Gold Canyon, AZ 85118-2963 | 2008-07-29 |
| 1740442573 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 10210 N. 92nd St, Suite 301, Scottsdale, AZ 85258 | 2008-07-02 |
| 1558523381 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 18700 N. 64th Dr, Suite 101, Glendale, AZ 85308 | 2008-07-02 |
| 1609038439 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 6036 N. 19th Ave, Suite 312, Phoenix, AZ 85015 | 2008-07-02 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
Please comment or provide details below to improve the information on PANACEA BRAIN AND SPINE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.