Provider Demographics
NPI:1508010471
Name:RCHP-SIERRA VISTA INC
Entity Type:Organization
Organization Name:RCHP-SIERRA VISTA INC
Other - Org Name:TOMBSTONE FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-884-9849
Mailing Address - Street 1:300 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2812
Mailing Address - Country:US
Mailing Address - Phone:520-417-3001
Mailing Address - Fax:520-417-3297
Practice Address - Street 1:7 NORTH SAN DIEGO STREET
Practice Address - Street 2:
Practice Address - City:TOMBSTONE
Practice Address - State:AZ
Practice Address - Zip Code:85638
Practice Address - Country:US
Practice Address - Phone:520-417-3001
Practice Address - Fax:520-417-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ030043Medicare Oscar/Certification