HAVASU EMERGENCY PHYSICIANS, PC (NPI# 1023113966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023113966 |
| Entity Type | Organization |
| Organization Name | HAVASU EMERGENCY PHYSICIANS, PC |
| Practice Address |
101 Civic Center Ln Lake Havasu City AZ 86403-5607 |
| Mailing Address |
Po Box 661454 Arcadia CA 91066-1454 |
| Practice Telephone | 9284530150 |
| Mailing Telephone | 6264470296 |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-02-26 |
| Authorized Official Name | DR. DEBRA A. GULYANICS (MANAGING PARTNER) |
| Authorized Official Telephone | 9284530150 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS | 423632 | 01 |
| AZ | XGG007110 | 05 |
| Street Address |
101 CIVIC CENTER LN |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176233 | Pamela B. Reband | Anesthesiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2005-06-28 |
| 1659995652 | Alana Stern | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2020-06-04 |
| 1245702927 | Michael Barber | Registered Nurse | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2018-12-19 |
| 1891276630 | Brian Andrew | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2018-08-28 |
| 1497264873 | Pinnacle Radiology Services | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-28 |
| 1821516287 | Jaime Wasik | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-06 |
| 1144776055 | Paul Queior | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-08-30 |
| 1891146957 | Misty Maple | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-06-29 |
| 1316319460 | Sarah Fraser | Specialist/Technologist, Other | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2015-10-28 |
| 1780067280 | Samer Asem Haddad | Internal Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2015-07-01 |
| Find all providers in the same location | ||||
| 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 | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508868654 | Randal L. Troyer | Emergency Medicine | 2035 Mesquite Ave Ste A, Lake Havasu City, AZ 86403-5894 | 2005-08-10 |
| 1932610482 | Hrmc, LLC | Emergency Medicine | 1799 Kiowa Ave Ste 104, Lake Havasu City, AZ 86403-2867 | 2017-10-23 |
| 1295090355 | David Carling Watts | Emergency Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2012-07-05 |
| 1871729038 | Tizon Emergency Associates, Pllc | Emergency Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2009-06-02 |
| 1457527806 | Emergency Physicians Medical Group | Emergency Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2008-05-06 |
| 1851338917 | Peter Dux | Emergency Medicine | 1720 Mesquite Ave, Suite 100, Lake Havasu City, AZ 86403-5602 | 2006-05-31 |
| 1477590537 | Brian Peters | Emergency Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2006-05-31 |
| 1003860842 | Mark Chorebanian | Emergency Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2006-05-19 |
| 1760432793 | Michele Ann Preston | Emergency Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2006-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627815 | Fep Ncch | Emergency Medicine | 8825 N 23rd Ave Ste 100, Phoenix, AZ 85021-4148 | 2020-10-22 |
| 1780202804 | Cep America- Arizona, PC | Emergency Medicine | 1405 S. Alma School Rd., Chandler, AZ 85286 | 2020-07-07 |
| 1932755006 | Ucc Tucson Holdings, LLC. | Emergency Medicine | 18773 S Nogales Hwy Ste 125, Green Valley, AZ 85614-0403 | 2019-08-14 |
| 1831652189 | Derek Allan Hatfield | Emergency Medicine | 1625 N Campbell Ave., Tucson, AZ 85719 | 2019-04-12 |
| 1053874305 | Travis Patrick Martin | Emergency Medicine | 1625 N. Campbell Ave, Tucson, AZ 85719 | 2019-04-12 |
| 1245793504 | Martin Cisneroz | Emergency Medicine | 1625 North Campbell Avenue, Tucson, AZ 85719 | 2019-04-12 |
| 1174086722 | Sarah Joy Ring | Emergency Medicine | 1625 N. Campbell Ave., Tucson, AZ 85719 | 2019-04-10 |
| 1386106391 | Joshua Lee Price | Emergency Medicine | 708 S Coeur D Alene Ln Ste A, Payson, AZ 85541-5662 | 2019-04-01 |
| 1346708708 | Colonna Physician Services LLC | Emergency Medicine | 4030 N Stockton Hill Rd Ste 3, Kingman, AZ 86409-2452 | 2019-03-05 |
| 1609304633 | Vincent Guarino | Emergency Medicine | 5700 E, Az-90, Sierra Vista, AZ 85635 | 2017-06-04 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| 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.