Healthcare Provider Details

I. General information

NPI: 1992967780
Provider Name (Legal Business Name): COBRE VALLEY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S TILBURY DR
KEARNY AZ
85137
US

IV. Provider business mailing address

PO BOX 519
KEARNY AZ
85237-0519
US

V. Phone/Fax

Practice location:
  • Phone: 520-363-5573
  • Fax: 520-363-5611
Mailing address:
  • Phone: 520-363-5573
  • Fax: 520-363-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH0126
License Number StateAZ

VIII. Authorized Official

Name: MR. FRANK A STAPLETON
Title or Position: REGIONAL CLINICS DIRECTOR
Credential:
Phone: 928-402-1131