Cobre Valley Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · Young, AZ
NPI 1811962848 · NPPES record last updated Aug 10, 2018
Key facts
- NPI
- 1811962848
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- OTC 0508 (AZ)
- Legal business name
- COBRE VALLEY REGIONAL MEDICAL CENTER
- Practice address
- 124 N Tewksbury Blvd
Young, AZ 85554 - Phone
- (928) 462-3435
- Fax
- (928) 462-6644
- NPI assigned
- Feb 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Neal D. Jensen
- Title
- Cfo
- Phone
- (928) 425-3261
Owners & managing parties with NPI records 11
-
Alan K. Osumi, MD
Other NPIs on the same Medicare enrollment 1
Related certifications (CCN) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Rural health clinic certification: CCN 038500
- Legal name
- COBRE VALLEY REGIONAL MEDICAL CENTER
- Doing business as
- PLEASANT VALLEY COMMUNITY MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 16, 2010
- Last certification
- Mar 5, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 29, 1988 in AZ
- Enrollment address
- 124 N Tewksbury Blvd
Young, AZ 85554 - Related CCNs
- 031314
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Cobre Valley Regional Medical Center |
5% Or Greater Direct Ownership Interest | Jul 10, 1998 | |
| Jack Bradford |
Corporate Director |
Jun 23, 2022 | |
| Jody Daggett |
Corporate Director |
Jan 20, 2016 | |
| Edward Carpenter |
Corporate Director | Oct 24, 2006 | |
| Nick Renon |
Corporate Director | Jul 28, 2025 | |
| Paula Horn |
Corporate Director |
Feb 22, 2024 | |
| Neal Duane Jensen |
Contracted Managing Employee |
Jul 10, 1998 | |
| Corporate Officer |
Jul 10, 1998 | ||
| Alan Osumi |
Corporate Director | Mar 1, 2015 | |
| Robert E Hollis |
Corporate Director | Jul 22, 2014 | |
| Jendean G Sartain |
Corporate Director | Mar 1, 2008 | |
| Fernando Shipley |
Corporate Director | Aug 1, 2004 | |
| Judy Bessee |
Corporate Director |
Feb 28, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030925000001 | AZ | Part a Provider - Rural Health Clinic | 0648181693 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Young, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | OTC 0508 | AZ | Yes |
Addresses
Primary practice location
124 N Tewksbury Blvd
Young, AZ 85554
Mailing address
PO Box 177
Young, AZ 85554-0177
Phone (928) 462-3435
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 934419 | Medicaid | AZ |
Other names
- Pleasant Valley Community Medical Center
Other providers in Young, AZ
- Linda Christy
- Cobre Valley Regional Medical Center
- Pleasant Valley Fire District
- Jo Anne Rye
- Young Elementary School District #5
All providers in Young, 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 Aug 10, 2018. 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.