Provider Demographics
NPI:1780996223
Name:BULLHEAD CITY HOSPITAL CORPORATION
Entity type:Organization
Organization Name:BULLHEAD CITY HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 847173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7173
Mailing Address - Country:US
Mailing Address - Phone:928-763-2273
Mailing Address - Fax:
Practice Address - Street 1:2500 CANYON RD
Practice Address - Street 2:BLDG B, UNIT 2
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8689
Practice Address - Country:US
Practice Address - Phone:928-763-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BULLHEAD CITY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-13
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0206770OtherBC
AZ030101Medicare Oscar/Certification