Provider Demographics
NPI:1225438104
Name:BISBEE HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:BISBEE HOSPITAL ASSOCIATION
Other - Org Name:COPPER QUEEN MEDICAL ASSOCIATES PALOMINAS
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:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-432-3400
Mailing Address - Street 1:10524 E HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-8371
Mailing Address - Country:US
Mailing Address - Phone:520-366-0300
Mailing Address - Fax:520-432-8018
Practice Address - Street 1:10524 E HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8371
Practice Address - Country:US
Practice Address - Phone:520-366-0300
Practice Address - Fax:520-432-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0098261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033996Medicare Oscar/Certification