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CAH031312-04 Bisbee Hospital Association dba Copper Queen Community Hospital (Terminated)
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Main Details
Name
Bisbee Hospital Association dba Copper Queen Community Hospital
Subdivision Name
Copper Valley Home Health
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH031312-04
Medicare Provider Number
031312
Outpatient Facility Provider Number
037179
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/2/2016
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
Bisbee Hospital Association Dba Copper Queen Community Hospital
Heather A Lundstrom, Chief Financial Officer
(520) 432-6450
Primary Contact
Bisbee Hospital Association
Robert Seamon, CEO
(520) 432-6400
Addresses
Street Address
101 Cole Ave
Bisbee, AZ 85603
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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