Provider Demographics
NPI:1295880722
Name:MOHAVE PULMONARY AND SLEEP DISORDER CLINIC, INC
Entity type:Organization
Organization Name:MOHAVE PULMONARY AND SLEEP DISORDER CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-758-2002
Mailing Address - Street 1:PO BOX 20245
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-0245
Mailing Address - Country:US
Mailing Address - Phone:928-758-2002
Mailing Address - Fax:928-758-1884
Practice Address - Street 1:2771 SILVER CREEK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7959
Practice Address - Country:US
Practice Address - Phone:928-758-2002
Practice Address - Fax:928-758-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0722040OtherBCBS PROVIDER ID
AZ421488Medicaid
CAXPY202551Medicaid
AZAZ0722040OtherBCBS PROVIDER ID
CAXPY202551Medicaid
AZ71360Medicare PIN