MEDICARE: APACHE JUNCTION HOSPITAL, LLC

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
1	282N00000X	General Acute Care Hospital		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790016244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APACHE JUNCTION HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 52163
Second Line	:	MSC # 170
City	:	PHOENIX
State	:	AZ
Zip	:	85072-2163
Country	:	US
Telephone Number	:	480-898-3333
Fax Number	:	480-223-4236

Provider Business Practice Location Address
First Line	:	2050 W SOUTHERN AVE
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85120-7305
Country	:	US
Telephone Number	:	480-237-3200
Fax Number	:	480-237-3206

Authorized Official
Title or Position	:	VP
Name	:	NANCY CRABTREE
Credential	:
Telephone Number	:	480-898-3333

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	03/15/2013

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