Provider Demographics
NPI:1689874943
Name:COCHISE SURGICAL CARE, PLLC
Entity Type:Organization
Organization Name:COCHISE SURGICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-452-0144
Mailing Address - Street 1:75 COLONIA DE SALUD STE 100C
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2485
Mailing Address - Country:US
Mailing Address - Phone:520-452-0144
Mailing Address - Fax:520-452-0075
Practice Address - Street 1:75 COLONIA DE SALUD STE 100C
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2485
Practice Address - Country:US
Practice Address - Phone:520-452-0144
Practice Address - Fax:520-452-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZA41097208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444362Medicaid
AZ444362Medicaid