Provider Demographics
NPI:1013060367
Name:NORTHERN COCHISE COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:NORTHERN COCHISE COMMUNITY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-384-3541
Mailing Address - Street 1:901 W REX ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1009
Mailing Address - Country:US
Mailing Address - Phone:520-384-3541
Mailing Address - Fax:520-384-0734
Practice Address - Street 1:901 W REX ALLEN DR
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1009
Practice Address - Country:US
Practice Address - Phone:520-384-3541
Practice Address - Fax:520-384-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRGH-0128282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020058Medicaid
AZ03Z302Medicare Oscar/Certification
AZZN03004101Medicare PIN
AZ033989Medicare Oscar/Certification
AZ035157Medicare Oscar/Certification
AZC13985Medicare Oscar/Certification
AZ020058Medicaid
AZ033992Medicare Oscar/Certification