Bisbee Hospital Association
Organization Active NPI Rural Health Clinic/Center · Hereford, AZ
NPI 1245986975 · NPPES record last updated Feb 23, 2022
Key facts
- NPI
- 1245986975
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BISBEE HOSPITAL ASSOCIATION
- Practice address
- 4524 E Hereford Rd
Hereford, AZ 85615-8813 - Phone
- (520) 432-2042
- NPI assigned
- Feb 22, 2022
- Organization subpart
- No
Authorized official
- Name
- Mr. Robert Seamon
- Title
- Ceo-Copper Queen Community Hospital
- Phone
- (520) 432-6400
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 7
Related certifications (CCN) 1
Practitioners 145
-
Erik Arellano Sr., M.D.
-
Peggy M Avina, MD
-
Nicole M. Chavez, N.P.
-
Maria Audrey Erspamer, APRN, PMHNP-BC
-
Chelsea L Finn, FNP-C
-
Mirna Lorena Franco, PMHNP
-
Kara L Gordon, DPM, MBA
-
Sheryl Kimberly Gore, F.N.P.
-
Joseph John Graca, PH.D.
-
Matthew J Johnson, P.A.
-
James Lindsey King, CRNA
-
Rebecca Lamas, FNP
-
Carrie Ann Langley, PHD, DNP-PMHNP-BC
-
Heidi L Lodge, MD
-
Misty Lee Lucero, CNM
-
Barbara K. McLaurin, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Rural health clinic certification: CCN 038521
- Legal name
- BISBEE HOSPITAL ASSOCIATION
- Doing business as
- COPPER QUEEN COMMUNITY HOSPITAL HEREFORD RHC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 27, 2023
- Last certification
- Feb 27, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jul 22, 1977 in AZ
- Enrollment address
- 4524 E Hereford Rd
Hereford, AZ 85615 - Related CCNs
- 031312
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| William P Coghlan |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Lawana M Diffie |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Sylvia Valenzuela |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Rosa a Lopez |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Heather Lundstrom |
Corporate Officer |
Nov 6, 2017 | 7.69% |
| Kathleen Heard |
Corporate Director |
Jan 1, 2022 | 7.69% |
| Peter Carberry |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Dennis Nelson |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Dennis Gallus |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Rebecca J Orozco |
Corporate Director |
Jan 1, 2020 | 7.69% |
| Laura Chavez |
Corporate Director |
Jan 1, 2022 | 7.69% |
| Robert Seamon |
Corporate Officer |
Aug 1, 2018 | 7.69% |
| W-2 Managing Employee |
Aug 1, 2018 | 7.69% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Copper Queen Medical Associates |
Rural health clinic | Operational/Managerial Control (100%) | Mar 31, 2009 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221012000897 | AZ | Part a Provider - Rural Health Clinic | 5092626168 | Practice locations: Hereford, AZ |
National Provider Directory
- Tax ID family
- Bisbee Hospital Association Dba CQCH
Locations
4524 E Hereford Rd
Ste 1
Hereford, AZ 85615
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Point of Service | 305S00000X |
Addresses
Primary practice location
4524 E Hereford Rd
Hereford, AZ 85615-8813
Mailing address
Copper Queen Community Hospital
101 Cole Ave
Bisbee, AZ 85603
Other names
- Copper Queen Community Hospital Hereford RHC
Other providers in Hereford, AZ
- American Geriatric Enterprise, Inc.
- Erik Arellano Sr.
- Jennifer Kay Barnett
- Lisa Ann Bilek
- Bisbee Hospital Association
- Leisa Diane Wilson Boyer
- Scott Burton
- Michelle Lynne Capers
- Anne M Castello
- Kelly Michelle Ceniceros
All providers in Hereford, AZ · Rural Health Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.