Provider Demographics
NPI:1083639983
Name:LA PAZ REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:LA PAZ REGIONAL HOSPITAL, INC.
Other - Org Name:DBA LA PAZ HELATHCARE PARKER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-669-7300
Mailing Address - Street 1:1200 W MOHAVE RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-6349
Mailing Address - Country:US
Mailing Address - Phone:928-669-9201
Mailing Address - Fax:928-669-7417
Practice Address - Street 1:601 W RIVERSIDE DR STE 3
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5119
Practice Address - Country:US
Practice Address - Phone:928-669-5550
Practice Address - Fax:928-669-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC5490261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCG7880OtherMEDICAR RR
AZ480046Medicaid
AZ944148Medicaid
AZ038504Medicare Oscar/Certification
AZZP03006701Medicare PIN