Basic Information
| Provider Information | |||||||||
| NPI: | 1790016244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APACHE JUNCTION HOSPITAL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARIZONA REGIONAL MEDICAL CENTER-APACHE JUNCTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 52163 | ||||||||
| Address2: | MSC # 170 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850722163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808983333 | ||||||||
| FaxNumber: | 4802234236 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 W SOUTHERN AVE | ||||||||
| Address2: | |||||||||
| City: | APACHE JUNCTION | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851207305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802373200 | ||||||||
| FaxNumber: | 4802373206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2010 | ||||||||
| LastUpdateDate: | 03/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | CRABTREE | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 4808983333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | APACHE JUNCTION HOSPITAL, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | AZ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 500470 | 05 | AZ | MEDICAID |