Healthcare Provider Details

I. General information

NPI: 1548591720
Provider Name (Legal Business Name): COBRE VALLEY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 S HOSPITAL DRIVE
GLOBE AZ
85501-9447
US

IV. Provider business mailing address

5880 S HOSPITAL DRIVE
GLOBE AZ
85501-9447
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3261
  • Fax: 928-425-7903
Mailing address:
  • Phone: 928-425-3261
  • Fax: 928-425-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34324
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH0126
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number27116
License Number StateAZ

VIII. Authorized Official

Name: NEAL D JENSEN
Title or Position: CEO
Credential:
Phone: 928-425-3261