NPIMap

Organization Active NPI

Mt Graham Regional Medical Center Inc

Doing business as Copper Mountain Clinic

  • Rural Health Clinic/Center
  • Safford, AZ
National Provider Identifier
1346528759
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MT GRAHAM REGIONAL MEDICAL CENTER INC
Doing business as
Copper Mountain Clinic
Practice address
2175 W 16TH St
Safford, AZ 85546-0011
Phone
(928) 348-4037
Fax
(844) 271-2379
NPI assigned
Aug 2, 2011
Last updated
Nov 7, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MT GRAHAM REGIONAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

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

Authorized official

Name
Diane Hansen
Title
Director Outpatient Clinics
Phone
(928) 348-4037

Specialties & licenses 1

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

Addresses

Primary practice location

2175 W 16TH St
Safford, AZ 85546-0011

Mailing address

2175 W 16TH St
Safford, AZ 85546-0011
Phone (928) 348-4037

Other identifiers 2

IdentifierTypeStateIssuer
920739MedicaidAZ
964830MedicaidAZ

Other names 1

  • Copper Mountain Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120620000593 AZ Part A Provider - Rural Health Clinic 6204822364 Practice locations: Safford, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346528759. Details of each certification follow.

Rural health clinic certification: CCN 038503

Legal name
MT GRAHAM REGIONAL MEDICAL CENTER INC
Doing business as
COPPER MOUNTAIN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 25, 2012
Last certification
Oct 22, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 25, 1973 in AZ
Enrollment address
2175 W 16TH St
Unit D
Safford, AZ 85546-0842
Related CCNs
031319

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

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2106083Mt Graham Regional Medical Center - Copper2175 W 16TH St Ste D, Safford, AZ 85546Certificate of waiverDec 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mt Graham Community Hos4 organizations share this tax ID, including this one
Part of
Mt Graham Community Hos

Other organizations with this tax ID 3

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2175 W 16th St
Unit D
Safford, AZ 85546
Phone (928) 348-1600

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Janet Oesterling Individual Corporate DirectorBoard Member Dec 20, 2010
Diane Hansen Individual W-2 Managing EmployeeDirector of Outpatient Clinics Jun 1, 2014 100%
Cynthia L Bryce Individual Corporate DirectorBoard Member Dec 20, 2011
Roland Knox Individual Corporate OfficerCeo Nov 29, 2019 100%
W-2 Managing EmployeeChief Executive Officer Nov 29, 2019
Operational/Managerial ControlChief Executive Officer Nov 29, 2019 100%
Matt Clifford Individual Corporate DirectorBoard Member Dec 20, 2008
Rex D Bryce Individual Corporate DirectorBoard - Vice Chief of Staff Jan 1, 2012
Lori Ray Individual Corporate OfficerVP & Chief Nursing Officer May 1, 2005
Carolina Gaethje Individual Corporate DirectorBoard - Chairman Finance & Perso Dec 20, 2010
Steve Goodman Individual Corporate DirectorBoard Member Dec 20, 2009
Susan J Jones Individual Corporate DirectorBoard Member Dec 20, 2010
Bart J Carter Individual Corporate DirectorBoard Member - District Pres Fin Dec 20, 2010
Carolyn J McCormies Individual Corporate DirectorBoard Member Dec 20, 2010
Kathleen L Williams Individual Corporate OfficerCfo Mar 4, 2021
Jean L Reynolds Individual Corporate DirectorBoard Member Finance/Personnel Dec 20, 2007

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mt Graham Regional Medical Center IncSafford, AZ, CCN 031319 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 14, 1970
Mt. Graham Regional Medical CenterSafford, AZ, CCN 03Z319 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 14, 1970

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 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762473600000",
    "number": "1346528759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 W 16TH ST",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855460011",
            "telephone_number": "928-348-4037",
            "fax_number": "844-271-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 W 16TH ST",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855460011",
            "telephone_number": "928-348-4037",
            "fax_number": "844-271-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT GRAHAM REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MT GRAHAM REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2011-08-02",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "DIRECTOR OUTPATIENT CLINICS",
        "authorized_official_telephone_number": "928-348-4037"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "920739",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "964830",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Mountain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Safford, AZ

Sources for this page

Verify at the official NPI Registry.