Provider Demographics
NPI:1437557642
Name:NORTHERN COCHISE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:NORTHERN COCHISE COMMUNITY HOSPITAL
Other - Org Name:SUNSITES MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-384-3541
Mailing Address - Street 1:223 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625
Mailing Address - Country:US
Mailing Address - Phone:520-826-1088
Mailing Address - Fax:
Practice Address - Street 1:901 W REX ALLEN DR
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1009
Practice Address - Country:US
Practice Address - Phone:520-384-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
033989Medicare Oscar/Certification