1992967780 NPI number — COBRE VALLEY REGIONAL MEDICAL CENTER

Table of content: (NPI 1992967780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992967780 NPI number — COBRE VALLEY REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COBRE VALLEY REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992967780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 519
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85237-0519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-363-5573
Provider Business Mailing Address Fax Number:
520-363-5611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S TILBURY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-363-5573
Provider Business Practice Location Address Fax Number:
520-363-5611
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STAPLETON
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
REGIONAL CLINICS DIRECTOR
Authorized Official Telephone Number:
928-402-1131

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  H0126 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1992967780 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 934437 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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