Provider Demographics
NPI:1598840258
Name:EL CENTRO REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:EL CENTRO REGIONAL MEDICAL CENTER
Other - Org Name:CALEXICO OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT FINANCIAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BENAVIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-482-5334
Mailing Address - Street 1:1415 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4306
Mailing Address - Country:US
Mailing Address - Phone:760-339-7495
Mailing Address - Fax:760-339-7389
Practice Address - Street 1:495 E BIRCH ST STE A
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2374
Practice Address - Country:US
Practice Address - Phone:760-357-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18536FMedicaid
CARHM18536FMedicaid