Provider Demographics
NPI:1942299649
Name:EL DORADO HOSPITAL
Entity Type:Organization
Organization Name:EL DORADO HOSPITAL
Other - Org Name:EL DORADO HOSPITAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SR VP - CFO
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANPIENGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-324-1160
Mailing Address - Street 1:1400 N WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4409
Practice Address - Country:US
Practice Address - Phone:520-721-5116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH-3500273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ840365Medicaid
AZ840365Medicaid