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General NPI Number Information
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NPI Number | 1548591720
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Entity Type | Organization
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Legal Business Name | COBRE VALLEY REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 5880 S HOSPITAL DRIVE
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City | GLOBE
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State | AZ
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Zip | 85501-9447
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Country | US
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Telephone | 928-425-3261
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Fax | 928-425-7903
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Provider Business Mailing Address
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Address Line | 5880 S HOSPITAL DRIVE
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City | GLOBE
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State | AZ
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Zip | 85501-9447
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Country | US
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Telephone | 928-425-3261
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Fax | 928-425-7903
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Authorized Official
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Title or Position | CEO
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Name | NEAL D JENSEN
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Credential |
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Telephone | 928-425-3261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34324
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | H0126
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 27116
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License Number State | AZ
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