NPIMap

Organization Active NPI

Bisbee Hospital Association

Doing business as Copper Queen Medical Associates Palominas

  • Rural Health Clinic/Center
  • Hereford, AZ
National Provider Identifier
1225438104
Registry record updated Aug 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0098 Issued in AZ
Legal business name
BISBEE HOSPITAL ASSOCIATION
Doing business as
Copper Queen Medical Associates Palominas
Practice address
10524 E Highway 92
Hereford, AZ 85615-8371
Phone
(520) 366-0300
Fax
(520) 432-8018
NPI assigned
Aug 28, 2014
Last updated
Aug 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. James Dickson
Title
Ceo
Phone
(520) 432-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0098 AZ Primary

Addresses

Primary practice location

10524 E Highway 92
Hereford, AZ 85615-8371

Mailing address

10524 E Highway 92
Hereford, AZ 85615-8371
Phone (520) 366-0300

Other names 1

  • Copper Queen Medical Associates Palominas Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623001007 AZ Part B Supplier - Clinic/Group Practice 5092626168 Receives reassigned benefits from 134 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bisbee, AZ; Hereford, AZ; Douglas, AZ

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Copper Queen Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10524 E Highway 92
Hereford, AZ 85615
Phone (520) 366-0300

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409184000000",
    "number": "1225438104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10524 E HIGHWAY 92",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856158371",
            "telephone_number": "520-366-0300",
            "fax_number": "520-432-8018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10524 E HIGHWAY 92",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856158371",
            "telephone_number": "520-366-0300",
            "fax_number": "520-432-8018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISBEE HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-28",
        "last_updated": "2014-08-28",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-432-3400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "H0098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Queen Medical Associates Palominas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hereford, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.