Basic Information
| Provider Information | |||||||||
| NPI: | 1013060367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN COCHISE COMMUNITY HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 W REX ALLEN DR | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203843541 | ||||||||
| FaxNumber: | 5203840734 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 W REX ALLEN DR | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203843541 | ||||||||
| FaxNumber: | 5203840734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | KNOX | ||||||||
| AuthorizedOfficialFirstName: | ROLAND | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5203843541 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | RGH-0128 | AZ | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 020058 | 05 | AZ | MEDICAID |