Healthcare Provider Details

I. General information

NPI: 1346291648
Provider Name (Legal Business Name): VERDE VALLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 S CANDY LN
COTTONWOOD AZ
86326-4158
US

IV. Provider business mailing address

1200 N BEAVER ST ATTN: MANAGED CARE CONTRACTING
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2546
  • Fax: 928-213-6292
Mailing address:
  • Phone: 928-213-6543
  • Fax: 928-214-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH-122
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateAZ

VIII. Authorized Official

Name: ROBERT COFIELD
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 928-773-2010