Provider Demographics
NPI:1902897820
Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:YAVAPAI REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-771-5695
Mailing Address - Street 1:1003 WILLOW CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-759-5997
Mailing Address - Fax:928-771-5722
Practice Address - Street 1:1003 WILLOW CREEK ROAD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-445-2700
Practice Address - Fax:928-458-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH-0115282N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0062457OtherAETNA
AZ020420Medicaid
AZAZ0000090OtherAZ BLUE CROSS
AZ030012Medicare Oscar/Certification
AZ020420Medicaid
AZZY03001201Medicare PIN