Healthcare Provider Details

I. General information

NPI: 1205327582
Provider Name (Legal Business Name): BENSON HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 W 4TH ST STE B
BENSON AZ
85602
US

IV. Provider business mailing address

450 S OCOTILLO AVE
BENSON AZ
85602-6403
US

V. Phone/Fax

Practice location:
  • Phone: 520-720-6512
  • Fax: 520-720-6522
Mailing address:
  • Phone: 520-586-2261
  • Fax: 520-586-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH096
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH GORANSON
Title or Position: CFO
Credential:
Phone: 520-586-2261