Provider Demographics
NPI:1871534487
Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-771-5564
Mailing Address - Street 1:7700 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2245
Mailing Address - Country:US
Mailing Address - Phone:928-759-5997
Mailing Address - Fax:928-771-5722
Practice Address - Street 1:7700 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2245
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:2006-06-08
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3964282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZIZ 0312OtherHEALTH NET
AZ118951Medicaid
AZAZ042520OtherBLUE CROSS PROVIDER #
AZAZ042520OtherBLUE CROSS PROVIDER #
AZ118951Medicaid
030118Medicare UPIN