Provider Demographics
NPI: | 1407617871 |
---|---|
Name: | COMMUNITY HOSPITAL |
Entity Type: | Organization |
Organization Name: | COMMUNITY HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ZACHARY |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | MILLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 304-534-7054 |
Mailing Address - Street 1: | 2901 N CENTRAL AVE STE 160 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85012-2702 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-747-4000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 625 ALBANY AVE |
Practice Address - Street 2: | |
Practice Address - City: | TORRINGTON |
Practice Address - State: | WY |
Practice Address - Zip Code: | 82240-1530 |
Practice Address - Country: | US |
Practice Address - Phone: | 307-532-2107 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BANNER HEALTH |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2024-01-22 |
Last Update Date: | 2024-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |