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NPI Code Detail

MEDICARE: PAYSON HOSPITAL CORPORATION

MEDICARE: PAYSON HOSPITAL CORPORATION
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1275N00000XMedicare Defined Swing Bed Hospital UnitH0089AZ

General Provider Information

NPI Number : 1760454052
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAYSON HOSPITAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 844825
Second Line :
City : DALLAS
State : TX
Zip : 75284-4825
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 807 S PONDEROSA ST
Second Line :
City : PAYSON
State : AZ
Zip : 85541-5542
Country : US
Telephone Number : 928-474-3222
Fax Number :
Authorized Official
Title or Position : SENIOR VP, GROUP OPERATIONS
Name : MICHAEL PORTACCI
Credential :
Telephone Number : 888-373-9600
Provider Enumeration Date : 02/02/2006
Last Update Date : 11/14/2007

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Directions to “PAYSON HOSPITAL CORPORATION ” Practice Location

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