Provider Demographics
NPI:1518968767
Name:BISBEE HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:BISBEE HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICKSON
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:520-432-5383
Mailing Address - Fax:520-432-5082
Practice Address - Street 1:101 COLE AVE
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1327
Practice Address - Country:US
Practice Address - Phone:520-432-6481
Practice Address - Fax:520-432-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH-0098282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020032Medicaid
AZ03Z312Medicare Oscar/Certification
AZ031312Medicare Oscar/Certification
AZ033829Medicare ID - Type UnspecifiedDOUGLAS CLINIC
AZ033830Medicare ID - Type UnspecifiedBISBEE CLINIC
AZ037179Medicare ID - Type UnspecifiedHOME HEALTH
030027Medicare ID - Type Unspecified