Provider Demographics
NPI:1629093539
Name:LA PAZ REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:LA PAZ REGIONAL HOSPITAL, INC.
Other - Org Name:TRI-VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-669-7300
Mailing Address - Street 1:1200 W MOHAVE RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-6349
Mailing Address - Country:US
Mailing Address - Phone:928-669-9201
Mailing Address - Fax:928-669-7417
Practice Address - Street 1:39726 HARQUAHALA ROAD
Practice Address - Street 2:
Practice Address - City:SALOME
Practice Address - State:AZ
Practice Address - Zip Code:85348
Practice Address - Country:US
Practice Address - Phone:928-859-3460
Practice Address - Fax:928-859-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0138261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480046Medicaid
AZCG7880OtherMEDICARE RR
AZ033994Medicare ID - Type Unspecified
AZZP03006701Medicare PIN