Healthcare Provider Details

I. General information

NPI: 1023632973
Provider Name (Legal Business Name): BENSON HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W 4TH ST
BENSON AZ
85602-6437
US

IV. Provider business mailing address

450 S OCOTILLO AVE
BENSON AZ
85602-6403
US

V. Phone/Fax

Practice location:
  • Phone: 520-586-3664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRET HICKS
Title or Position: CFO
Credential:
Phone: 520-324-1614