Provider Demographics
NPI:1275588345
Name:MT GRAHAM REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MT GRAHAM REGIONAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:928-348-4000
Mailing Address - Street 1:1600 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546
Mailing Address - Country:US
Mailing Address - Phone:928-348-4000
Mailing Address - Fax:928-348-4018
Practice Address - Street 1:1600 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546
Practice Address - Country:US
Practice Address - Phone:928-348-4000
Practice Address - Fax:928-348-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
AZH0140282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZIZ0074OtherHEALTHNET
AZ196396Medicaid
AZAZ0701200OtherBCBS HOMEHEALTH
AZ020082Medicaid
AZAZ0000940OtherBCBS HOSPITAL
AZAZ0701210OtherBCBS HOSPICE
AZAZ0000940OtherBCBS HOSPITAL
AZ037312Medicare ID - Type UnspecifiedHOMEHEALTH
AZAZ0701200OtherBCBS HOMEHEALTH
AZAZ0701210OtherBCBS HOSPICE
AZ020082Medicaid