Healthcare Provider Details

I. General information

NPI: 1013060367
Provider Name (Legal Business Name): NORTHERN COCHISE COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

IV. Provider business mailing address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

V. Phone/Fax

Practice location:
  • Phone: 520-384-3541
  • Fax: 520-384-0734
Mailing address:
  • Phone: 520-384-3541
  • Fax: 520-384-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberRGH-0128
License Number StateAZ

VIII. Authorized Official

Name: MR. ROLAND KNOX
Title or Position: CEO
Credential:
Phone: 520-384-3541