Provider Demographics
NPI:1245986975
Name:BISBEE HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:BISBEE HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO-COPPER QUEEN COMMUNITY HOSPITAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-432-6400
Mailing Address - Street 1:COPPER QUEEN COMMUNITY HOSPITAL
Mailing Address - Street 2:101 COLE AVE
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4524 E HEREFORD RD
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8813
Practice Address - Country:US
Practice Address - Phone:520-432-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No305S00000XManaged Care OrganizationsPoint of Service