Basic Information
| Provider Information | |||||||||
| NPI: | 1336270883 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUSA REGIONAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | COLUSA REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 E WEBSTER ST | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304585821 | ||||||||
| FaxNumber: | 5304583210 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 E WEBSTER ST | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304585821 | ||||||||
| FaxNumber: | 5304583210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 09/24/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | LETITIA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFI | ||||||||
| AuthorizedOfficialTelephone: | 5304585821 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 230000149 | CA | N | Hospitals | General Acute Care Hospital | 275N00000X | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.