Provider Demographics
NPI:1841535317
Name:IRENE BENN MEDICAL CENTER
Entity type:Organization
Organization Name:IRENE BENN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, PATIENT BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SKY
Authorized Official - Middle Name:RAINBOW
Authorized Official - Last Name:BLACK ELK-VOLKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-384-4844
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:MOAPA
Mailing Address - State:NV
Mailing Address - Zip Code:89025-0819
Mailing Address - Country:US
Mailing Address - Phone:775-784-5327
Mailing Address - Fax:
Practice Address - Street 1:10 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MOAPA
Practice Address - State:NV
Practice Address - Zip Code:89025-0819
Practice Address - Country:US
Practice Address - Phone:775-784-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHHS IHS PHOENIX AREA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-10
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center