Basic Information
| Provider Information | |||||||||
| NPI: | 1285845800 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MT GRAHAM REGIONAL MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 S 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAFFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855464011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283484000 | ||||||||
| FaxNumber: | 9283484018 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAFFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855464011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283484000 | ||||||||
| FaxNumber: | 9283484018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | PETERS | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHEIF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9283484000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | HS314 | AZ | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.