Provider Demographics
NPI:1649464454
Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-771-5691
Mailing Address - Street 1:1003 WILLOW CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1641
Mailing Address - Country:US
Mailing Address - Phone:928-771-5695
Mailing Address - Fax:928-458-2015
Practice Address - Street 1:804 AINSWORTH DRIVE STE. 103
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-445-2700
Practice Address - Fax:928-771-5785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3964208600000X
AZH0115208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty