Provider Demographics
NPI:1245899384
Name:COBRE VALLEY REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:COBRE VALLEY REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-402-1122
Mailing Address - Street 1:5990 S HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9462
Mailing Address - Country:US
Mailing Address - Phone:928-425-8151
Mailing Address - Fax:928-425-9425
Practice Address - Street 1:5990 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9462
Practice Address - Country:US
Practice Address - Phone:928-425-8151
Practice Address - Fax:928-425-9425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBRE VALLEY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty