NPIMap

Organization Active NPI

Bisbee Hospital Association

Doing business as Copper Queen Community Hospital Hereford RHC

  • Rural Health Clinic/Center
  • Hereford, AZ
National Provider Identifier
1245986975
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BISBEE HOSPITAL ASSOCIATION
Doing business as
Copper Queen Community Hospital Hereford RHC
Practice address
4524 E Hereford Rd
Hereford, AZ 85615-8813
Phone
(520) 432-2042
NPI assigned
Feb 22, 2022
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Mr. Robert Seamon
Title
Ceo-Copper Queen Community Hospital
Phone
(520) 432-6400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
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 1

  • Copper Queen Community Hospital Hereford RHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221012000897 AZ Part A Provider - Rural Health Clinic 5092626168 Practice locations: Hereford, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245986975. Details of each certification follow.

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
CorporationProprietary
Incorporated
Jul 22, 1977 in AZ
Enrollment address
4524 E Hereford Rd
Hereford, AZ 85615
Related CCNs
031312

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

4524 E Hereford Rd
Ste 1
Hereford, AZ 85615

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William P Coghlan Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Lawana M Diffie Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Sylvia Valenzuela Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Rosa a Lopez Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Heather Lundstrom Individual Corporate OfficerCfo Nov 6, 2017 7.69%
Kathleen Heard Individual Corporate DirectorTreasurer Jan 1, 2022 7.69%
Peter Carberry Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Dennis Nelson Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Dennis Gallus Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Rebecca J Orozco Individual Corporate DirectorBoard Member Jan 1, 2020 7.69%
Laura Chavez Individual Corporate DirectorBoard Member Jan 1, 2022 7.69%
Robert Seamon Individual Corporate OfficerCeo Aug 1, 2018 7.69%
W-2 Managing EmployeeCeo Aug 1, 2018 7.69%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Copper Queen Medical AssociatesDouglas, AZ, CCN 033829 Rural health clinic Operational/Managerial Control (100%) Mar 31, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 124

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.

View all 124

NPI Registry JSON

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1245986975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COPPER QUEEN COMMUNITY HOSPITAL",
            "address_2": "101 COLE AVE",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "85603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4524 E HEREFORD RD",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856158813",
            "telephone_number": "520-432-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISBEE HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-22",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "SEAMON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO-COPPER QUEEN COMMUNITY HOSPITAL",
        "authorized_official_telephone_number": "520-432-6400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Queen Community Hospital Hereford RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hereford, AZ

Sources for this page

Verify at the official NPI Registry.