Active NPI
Community Health Care of Douglas
Doing business as Southeast Arizona Medical Center
- Diagnostic Radiology Physician
- Douglas, AZ
National Provider Identifier
1205164688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- COMMUNITY HEALTH CARE OF DOUGLAS
- Doing business as
- Southeast Arizona Medical Center
- Practice address
- 2174 W Oak Ave
Douglas, AZ 85607 - Phone
- (520) 805-5813
- NPI assigned
- Nov 24, 2009
- Last updated
- Nov 24, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brian Bickell
- Title
- Ceo
- Phone
- (520) 805-5940
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
2174 W Oak Ave
Douglas, AZ 85607
Mailing address
2174 W Oak Ave
Douglas, AZ 85607-6003
Phone (520) 805-5813
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55843901 | Medicaid | AZ |
Other names 1
- Southeast Arizona Medical Center
National Provider Directory
National Provider Directory- Tax ID family
- Community Health Care of Douglas
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Southeast Arizona Medical Center
- Critical Access Hospital
- Douglas, AZ
- NPI 1427228212
-
- Clinical Medical Laboratory
- Douglas, AZ
- NPI 1083932784
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259020800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1259020800000",
"number": "1205164688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2174 W OAK AVE",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "856076003",
"telephone_number": "520-805-5813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2174 W OAK AVE",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "85607",
"telephone_number": "520-805-5813"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY HEALTH CARE OF DOUGLAS",
"organizational_subpart": "NO",
"enumeration_date": "2009-11-24",
"last_updated": "2009-11-24",
"status": "A",
"authorized_official_last_name": "BICKELL",
"authorized_official_first_name": "BRIAN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "520-805-5940"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "55843901",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Southeast Arizona Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Douglas, AZ
- Chiricahua Community Health Centers, Inc (Early Childhood Center of Excellance)
- Chiricahua Community Health Centers, Inc (Business Office)
- Chiricahua Community Health Centers, Inc. (Chiricahua Douglas Pharmacy)
- Russell L Christopher Jr., M.D.
- City of Douglas (City of Douglas Fire and Ambulance)
- Community Healthcare of Douglas (Southeast Arizona Medical Center)
- Community Healthcare of Douglas Inc (SAMC Clinic)
- Community Healthcare of Douglas Inc
- Community Healthcare of Douglas Inc (southeast arizona medical center)
- Community Healthcare of Douglas Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.