Provider Demographics
NPI:1508137209
Name:BISBEE HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:BISBEE HOSPITAL ASSOCIATION
Other - Org Name:COPPER QUEEN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAMON
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:520-432-2042
Mailing Address - Fax:
Practice Address - Street 1:7 BISBEE RD
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1140
Practice Address - Country:US
Practice Address - Phone:520-432-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BISBEE HOSPITAL ASSOCIATION COPPER QUEEN COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-26
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0098305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033830Medicare Oscar/Certification