Provider Demographics
NPI:1356923585
Name:BENSON HOSPITAL CORP
Entity type:Organization
Organization Name:BENSON HOSPITAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-324-1614
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:520-720-6512
Mailing Address - Fax:
Practice Address - Street 1:450 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6403
Practice Address - Country:US
Practice Address - Phone:520-586-2261
Practice Address - Fax:520-586-7283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENSON HOSPITAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020066Medicaid