Provider Demographics
NPI:1982733655
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-406-6571
Mailing Address - Street 1:3033 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4447
Mailing Address - Country:US
Mailing Address - Phone:602-307-2420
Mailing Address - Fax:
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3003273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
721561134OtherIRS - SP TAX ID
AZ721561134850130001OtherTRICARECHAMPUS
AZ721561134850130000OtherTRICARECHAMPUS
AZAZ0208840OtherBLUE CROSS BLUE SHIELD
AZAZ0208900OtherBLUE CROSS BLUE SHIELD
AZ691974Medicaid
AZ030024Medicare Oscar/Certification
AZ721561134850130001OtherTRICARECHAMPUS
AZ721561134850130000OtherTRICARECHAMPUS