Basic Information
| Provider Information | |||||||||
| NPI: | 1225274210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPITAL ASSOCIATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMMUNITY HOSPITAL CLINIC - WICKENBURG | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 523 ROSE LN | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853901448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286681833 | ||||||||
| FaxNumber: | 9286847457 | ||||||||
| Practice Location | |||||||||
| Address1: | 523 ROSE LN | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853901448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286681833 | ||||||||
| FaxNumber: | 9286847457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2008 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TAVARY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9286845421 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | RGH3505 | AZ | N | Hospitals | General Acute Care Hospital | Critical Access | 261QR1300X | OTC4928 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.