Basic Information
Provider Information
NPI: 1487022950
EntityType: 2
ReplacementNPI:  
OrganizationName: LA PAZ REGIONAL HOSPITAL INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: RIVER HEALTH CLINIC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 W MOHAVE RD
Address2:  
City: PARKER
State: AZ
PostalCode: 853446349
CountryCode: US
TelephoneNumber: 9286697400
FaxNumber: 9286697409
Practice Location
Address1: 1200 W MOHAVE RD
Address2:  
City: PARKER
State: AZ
PostalCode: 853446349
CountryCode: US
TelephoneNumber: 9286697380
FaxNumber: 9286697371
Other Information
ProviderEnumerationDate: 09/14/2015
LastUpdateDate: 01/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BROWN
AuthorizedOfficialFirstName: KEVIN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 9286697300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QH0100XHO138AZN Ambulatory Health Care FacilitiesClinic/CenterHealth Service
261QR1300XHO138AZY Ambulatory Health Care FacilitiesClinic/CenterRural Health

ID Information
IDTypeStateIssuerDescription
22281605AZ MEDICAID


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