Mt Graham Regional Medical Center Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

HSPC-43 Issued in AZ

Legal business name

MT GRAHAM REGIONAL MEDICAL CENTER INC

Practice address

1600 S. 20TH Ave
BLDG. E
Safford, AZ 85546

Phone

(928) 348-4063

Fax

(928) 348-3868

NPI assigned

Apr 25, 2006

Organization subpart

Yes

Parent organization

MT GRAHAM REGIONAL MEDICAL CENTER INCAs reported in NPPES

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

Authorized official

Name

Mr. Keith Bryce

Title

Cfo

Phone

(928) 348-4099

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mt. Graham Regional Medical Center Hospice Services Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Part of

Mt Graham Hospital

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Eden Hospice at Sierra Vista, LLC

  • Community Based Hospice Care Agency
  • Safford, AZ
  • NPI 1487131215

  Sold to, 2019-01-01

  CMS change of ownership

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1770549974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S. 20TH AVE",
            "address_2": "BLDG. E",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "85546",
            "telephone_number": "928-348-4063",
            "fax_number": "928-348-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S. 20TH AVE",
            "address_2": "BLDG. E",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "85546",
            "telephone_number": "928-348-4063",
            "fax_number": "928-348-3868"
        }
    ],
    "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": "2006-04-25",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "BRYCE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-348-4099",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AZ",
            "license": "HSPC-43",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "317786",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "03D0886073",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS NUMBER",
            "identifier": "HSPC-43",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Graham Regional Medical Center Hospice Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mt Graham Regional Medical Center Inc
• Mt Graham Regional Medical Center Inc
• Mt Graham Regional Medical Center Inc
• Mt Graham Regional Medical Center Inc
• Mt Graham Regional Medical Center Inc
• Mt. Graham Regional Medical Center, Inc.
• Mt. Graham Regional Medical Center, Inc.
• Jace Dobbie Nelson, PT, DPT
• Paul Wayne Nelson, DPT
• John P Nestor, D.O.

• Community Based Hospice Care Agency in Safford, AZ
• Providers in Safford, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.