Provider Demographics
NPI:1699103713
Name:COCHISE HEALTH AND WELLNESS PLC
Entity type:Organization
Organization Name:COCHISE HEALTH AND WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-226-8316
Mailing Address - Street 1:4669 N COMMERCE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2497
Mailing Address - Country:US
Mailing Address - Phone:520-226-8316
Mailing Address - Fax:877-303-6952
Practice Address - Street 1:4669 N COMMERCE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2497
Practice Address - Country:US
Practice Address - Phone:520-226-8316
Practice Address - Fax:877-303-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ575425Medicaid