Provider Demographics
NPI:1144799677
Name:COBRE VALLEY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:COBRE VALLEY REGIONAL MEDICAL CENTER
Other - Org Name:COBRE VALLEY TONTO BASIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-402-1122
Mailing Address - Street 1:5880 S HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9447
Mailing Address - Country:US
Mailing Address - Phone:928-425-3261
Mailing Address - Fax:
Practice Address - Street 1:186 E STEPHENS WAY
Practice Address - Street 2:
Practice Address - City:TONTO BASIN
Practice Address - State:AZ
Practice Address - Zip Code:85553
Practice Address - Country:US
Practice Address - Phone:928-479-2871
Practice Address - Fax:928-473-3200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBRE VALLEY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-14
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty