Healthcare Provider Details

I. General information

NPI: 1538232129
Provider Name (Legal Business Name): BULLHEAD CITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 SILVER CREEK RD
BULLHEAD CITY AZ
86442-7924
US

IV. Provider business mailing address

PO BOX 847173
DALLAS TX
75284-7173
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-2273
  • Fax:
Mailing address:
  • Phone: 928-763-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH0156
License Number StateAZ

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: SR. DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953