Provider Demographics
NPI:1225274210
Name:COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION, INC.
Other - Org Name:COMMUNITY HOSPITAL CLINIC - WICKENBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-684-5421
Mailing Address - Street 1:523 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1448
Mailing Address - Country:US
Mailing Address - Phone:928-668-1833
Mailing Address - Fax:928-684-7457
Practice Address - Street 1:523 ROSE LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1448
Practice Address - Country:US
Practice Address - Phone:928-668-1833
Practice Address - Fax:928-684-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4928261QR1300X
AZRGH3505282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033998Medicare Oscar/Certification