Healthcare Provider Details

I. General information

NPI: 1699398560
Provider Name (Legal Business Name): RIDGECREST REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E RIDGECREST BLVD STE 107
RIDGECREST CA
93555-3928
US

IV. Provider business mailing address

PO BOX 157
RIDGECREST CA
93556-0157
US

V. Phone/Fax

Practice location:
  • Phone: 760-375-6531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ANN LOCK
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 760-499-3899