Provider Demographics
NPI:1316267933
Name:MD HEALTH, INC.
Entity type:Organization
Organization Name:MD HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:INGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-227-6947
Mailing Address - Street 1:1990 MCCULLOCH BLVD N
Mailing Address - Street 2:D-215
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5749
Mailing Address - Country:US
Mailing Address - Phone:702-227-6947
Mailing Address - Fax:
Practice Address - Street 1:276 LAKE HAVASU AVE S
Practice Address - Street 2:#A-11
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0851
Practice Address - Country:US
Practice Address - Phone:928-453-0506
Practice Address - Fax:928-453-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ379032084N0400X, 2084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPTAN#143925Medicare PIN