Provider Demographics
NPI:1508893793
Name:SIERRA VISTA REGIONAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:SIERRA VISTA REGIONAL HEALTH CENTER INC
Other - Org Name:SIERRA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:520-417-3001
Mailing Address - Street 1:1967 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4606
Mailing Address - Country:US
Mailing Address - Phone:520-452-3864
Mailing Address - Fax:520-452-0466
Practice Address - Street 1:1967 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4606
Practice Address - Country:US
Practice Address - Phone:520-452-3864
Practice Address - Fax:520-452-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0620970001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER