Provider Demographics
NPI:1336118322
Name:BENSON HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:BENSON HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-720-6508
Mailing Address - Street 1:450 S OCOTILLO AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6403
Mailing Address - Country:US
Mailing Address - Phone:520-586-2261
Mailing Address - Fax:520-586-2265
Practice Address - Street 1:450 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602
Practice Address - Country:US
Practice Address - Phone:520-586-2261
Practice Address - Fax:520-586-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH-096282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020066Medicaid
AZ031301Medicare Oscar/Certification
AZ020066Medicaid