Provider Demographics
NPI:1609144393
Name:COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION, INC.
Other - Org Name:COMMUNITY HOSPITAL CLINIC - CONGRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-684-5421
Mailing Address - Street 1:520 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1447
Mailing Address - Country:US
Mailing Address - Phone:928-684-5421
Mailing Address - Fax:928-684-5081
Practice Address - Street 1:26750 S. SANTA FE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CONGRESS
Practice Address - State:AZ
Practice Address - Zip Code:85332
Practice Address - Country:US
Practice Address - Phone:928-668-1813
Practice Address - Fax:928-668-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ038502Medicare Oscar/Certification