Provider Demographics
NPI:1306021993
Name:BISBEE HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:BISBEE HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
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:520-432-6400
Mailing Address - Street 1:101 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1327
Mailing Address - Country:US
Mailing Address - Phone:520-432-1724
Mailing Address - Fax:
Practice Address - Street 1:101 COLE AVE
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1327
Practice Address - Country:US
Practice Address - Phone:520-432-1724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPPER VALLEY HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-02
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037179Medicare Oscar/Certification