Provider Demographics
NPI:1235154147
Name:LA PAZ REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:LA PAZ REGIONAL HOSPITAL, INC.
Other - Org Name:BOUSE MEDICAL 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 1:44031 E PLUMOSA ROAD
Practice Address - Street 2:
Practice Address - City:BOUSE
Practice Address - State:AZ
Practice Address - Zip Code:85325
Practice Address - Country:US
Practice Address - Phone:928-669-8512
Practice Address - Fax:928-851-1828
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCG7880OtherMEDICARE RR
AZZP03006701Medicare PIN
AZCG7880OtherMEDICARE RR