Provider Demographics
NPI:1538608716
Name:VERDE VALLEY MEDICAL CENTER
Entity type:Organization
Organization Name:VERDE VALLEY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-773-2010
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:ATTN: MANAGED CARE CONTRACTING
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6543
Mailing Address - Fax:928-214-3613
Practice Address - Street 1:3700 W HIGHWAY 89A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4937
Practice Address - Country:US
Practice Address - Phone:928-204-4100
Practice Address - Fax:928-204-4115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERDE VALLEY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-21
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0122282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020438Medicaid
AZ020438Medicaid