INNOVATIVE PRIMARY CARE CLINIC OF HAVASU PLLC (NPI# 1588097349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588097349 |
| Entity Type | Organization |
| Organization Name | INNOVATIVE PRIMARY CARE CLINIC OF HAVASU PLLC |
| Practice Address |
297 Lake Havasu Ave S Suite 106 Lake Havasu City AZ 86403-6526 |
| Mailing Address |
Po Box 27340 Phoenix AZ 85061-7340 |
| Practice Telephone | 9288547666 |
| Practice Fax Number | 9288547660 |
| Mailing Telephone | 6029439200 |
| Mailing Fax Number | 6022163000 |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-16 |
| Authorized Official Name | MS. JACQUELYN J. MEYER (PRESIDENT) |
| Authorized Official Telephone | 9288547666 |
| Authorized Official Credential | N.P. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
AP1654 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
297 LAKE HAVASU AVE S SUITE 106 |
| 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 |
| 1154765121 | Panacea Brain and Spine, LLC | Non-Pharmacy Dispensing Site | 297 Lake Havasu Ave S, Suite 204, Lake Havasu City, AZ 86403-6526 | 2013-04-22 |
| 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 | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447864202 | Soma Care, LLC | Nurse Practitioner | 6944 E Broadway Rd Ste A, Mesa, AZ 85208-1916 | 2020-08-31 |
| 1497367403 | Daryl Lyons | Nurse Practitioner | 18095 W Santa Irene Dr, Goodyear, AZ 85338-5456 | 2020-08-20 |
| 1538787072 | Brijeshaben Urvish Patel | Nurse Practitioner | 13300 N 88th Ave Apt 2007, Peoria, AZ 85381-2614 | 2020-07-10 |
| 1043835424 | Us Live Clinic LLC | Nurse Practitioner | 12610 E Laurel Ln, Scottsdale, AZ 85259-3460 | 2020-06-11 |
| 1831713148 | Alexis Petra Md | Nurse Practitioner | 21835 N 51st St, Phoenix, AZ 85054-7140 | 2020-06-02 |
| 1245851955 | Amy Rachelle Dunn | Nurse Practitioner | 7563 E Plata Ave, Mesa, AZ 85212-9729 | 2020-05-04 |
| 1700407426 | Joan N Nunoo | Nurse Practitioner | 3852 E Santa Fe Ln, Gilbert, AZ 85297-8529 | 2020-05-04 |
| 1326675166 | Kendrick Wright | Nurse Practitioner | 2727 E Camelback Rd Apt 525, Phoenix, AZ 85016-4481 | 2020-03-23 |
| 1518591510 | Laura Larson | Nurse Practitioner | 1929 W Fillmore St Bldg C, Phoenix, AZ 85009-3812 | 2020-02-27 |
| 1538791512 | Silverleaf Health LLC | Nurse Practitioner | 20715 N Pima Rd Ste 108, Scottsdale, AZ 85255-6685 | 2020-02-07 |
| 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 INNOVATIVE PRIMARY CARE CLINIC OF HAVASU PLLC.
| 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.