MEDICARE: COLUSA REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NR1301X	Rural Acute Care Hospital

General Provider Information

NPI Number	:	1144215427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUSA REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	199 E. WEBSTER STREET
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932
Country	:	US
Telephone Number	:	530-458-5821
Fax Number	:	530-458-3210

Provider Business Practice Location Address
First Line	:	199 E. WEBSTER STREET
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932
Country	:	US
Telephone Number	:	530-458-5821
Fax Number	:	530-458-3210

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFI
Name	:	LETITLA ANN MILLER
Credential	:
Telephone Number	:	530-458-5821

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	08/21/2014

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