Healthcare Provider Details

I. General information

NPI: 1003213828
Provider Name (Legal Business Name): COBRE VALLEY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

IV. Provider business mailing address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3261
  • Fax: 928-425-3859
Mailing address:
  • Phone: 928-425-3261
  • Fax: 928-425-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberH0126
License Number StateAZ

VIII. Authorized Official

Name: MR. NEAL D JENSEN
Title or Position: CEO
Credential:
Phone: 928-402-1122