Basic Information
| Provider Information | |||||||||
| NPI: | 1023632973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BENSON HOSPITAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 S OCOTILLO AVE | ||||||||
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| City: | BENSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856026403 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 890 W 4TH ST | ||||||||
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| City: | BENSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856026437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205863664 | ||||||||
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| ProviderEnumerationDate: | 06/05/2020 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | BRET | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5203241614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.