Provider Demographics
NPI:1720352685
Name:RIDGECREST REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:RIDGECREST REGIONAL HOSPITAL
Other - Org Name:TRONA RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SUVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-499-3902
Mailing Address - Street 1:1081 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-446-3551
Mailing Address - Fax:760-446-2254
Practice Address - Street 1:82820 TRONA RD
Practice Address - Street 2:
Practice Address - City:TRONA
Practice Address - State:CA
Practice Address - Zip Code:93562-1929
Practice Address - Country:US
Practice Address - Phone:760-446-3551
Practice Address - Fax:760-446-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QM1300X, 363LF0000X
CA120000186261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051333Medicare Oscar/Certification