Provider Demographics
NPI:1841964624
Name:BISBEE HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:BISBEE HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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:520-432-2042
Mailing Address - Fax:520-457-1485
Practice Address - Street 1:BISBEE HOSPITAL ASSOCIATION
Practice Address - Street 2:7 NORTH SAN DIEGO ST.
Practice Address - City:TOMBSTONE
Practice Address - State:AZ
Practice Address - Zip Code:85638
Practice Address - Country:US
Practice Address - Phone:520-432-2042
Practice Address - Fax:520-457-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No305S00000XManaged Care OrganizationsPoint of Service