Provider Demographics
NPI:1730109232
Name:COCHISE SURGICAL CARE PLLC
Entity Type:Organization
Organization Name:COCHISE SURGICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-452-0144
Mailing Address - Street 1:75 COLONIA DE SALUD
Mailing Address - Street 2:STE C100
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
Practice Address - Street 2:SUITE 100 C
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:2006-07-20
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0776250OtherBCBS PROVIDER ID
AZ322222Medicaid
AZ322222Medicaid
AZZ102044Medicare PIN