Healthcare Provider Details

I. General information

NPI: 1841964624
Provider Name (Legal Business Name): BISBEE HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BISBEE HOSPITAL ASSOCIATION 7 NORTH SAN DIEGO ST.
TOMBSTONE AZ
85638
US

IV. Provider business mailing address

COPPER QUEEN COMMUNITY HOSPITAL 101 COLE AVE
BISBEE AZ
85603
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-2042
  • Fax: 520-457-1485
Mailing address:
  • Phone: 520-432-2042
  • Fax: 520-457-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SEAMON
Title or Position: CEO
Credential:
Phone: 520-432-6400