Provider Demographics
NPI:1881665545
Name:PAYSON HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:PAYSON HOSPITAL CORPORATION
Other - Org Name:PAYSON REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR BUSINESS OFFICE SUP/AUTH OFFICI
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7488
Mailing Address - Street 1:807 S PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5542
Mailing Address - Country:US
Mailing Address - Phone:928-474-3222
Mailing Address - Fax:
Practice Address - Street 1:807 S PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5542
Practice Address - Country:US
Practice Address - Phone:928-474-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0089282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IZ0088OtherHEALTHNET
0912454OtherINTERGROUP
AZ405599Medicaid
PHH070030001OtherAHCCCS
1894383OtherDEPT OF LABOR
AZ0205320OtherBCBS
AZ0205320OtherBCBS