Healthcare Provider Details

I. General information

NPI: 1518968767
Provider Name (Legal Business Name): BISBEE HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLE AVE
BISBEE AZ
85603-1327
US

IV. Provider business mailing address

101 COLE AVE
BISBEE AZ
85603-1327
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-6481
  • Fax: 520-432-5082
Mailing address:
  • Phone: 520-432-5383
  • Fax: 520-432-5082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-0098
License Number StateAZ

VIII. Authorized Official

Name: MR. JAMES J DICKSON
Title or Position: CEO
Credential:
Phone: 520-432-6400