Provider Demographics
NPI:1144215427
Name:COLUSA REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:COLUSA REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFI
Authorized Official - Prefix:
Authorized Official - First Name:LETITLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-458-5821
Mailing Address - Street 1:199 E. WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932
Mailing Address - Country:US
Mailing Address - Phone:530-458-5821
Mailing Address - Fax:530-458-3210
Practice Address - Street 1:199 E. WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932
Practice Address - Country:US
Practice Address - Phone:530-458-5821
Practice Address - Fax:530-458-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050434Medicare Oscar/Certification