Provider Demographics
NPI:1457924920
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:
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:520-586-7283
Practice Address - Street 1:13370 E MARY ANN CLEVELAND WAY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-8610
Practice Address - Country:US
Practice Address - Phone:520-720-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health