MEDICARE: SIERRA VISTA REGIONAL HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	AZ
2	332BX2000X	Oxygen Equipment & Supplies (DME)	AZ
3	332B00000X	Durable Medical Equipment & Medical Supplies	AZ

General Provider Information

NPI Number	:	1508893793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA VISTA REGIONAL HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	1967 FRONTAGE RD
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4606
Country	:	US
Telephone Number	:	520-452-3864
Fax Number	:	520-452-0466

Provider Business Practice Location Address
First Line	:	1967 FRONTAGE RD
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4606
Country	:	US
Telephone Number	:	520-452-3864
Fax Number	:	520-452-0466

Authorized Official
Title or Position	:	CFO
Name	:	BRUCE NORTON
Credential	:	CPA
Telephone Number	:	520-417-3001

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	10/09/2007

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