Provider Demographics
NPI:1215968250
Name:COCHISE COUNTY
Entity type:Organization
Organization Name:COCHISE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MN
Authorized Official - Phone:520-432-9400
Mailing Address - Street 1:1415 W MELODY LN
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-3037
Mailing Address - Country:US
Mailing Address - Phone:520-432-9400
Mailing Address - Fax:520-432-9480
Practice Address - Street 1:1415 W MELODY LN
Practice Address - Street 2:BUILDING A
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-3037
Practice Address - Country:US
Practice Address - Phone:520-432-9400
Practice Address - Fax:520-432-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062802Medicaid
AZZ20310Medicare ID - Type Unspecified