Healthcare Provider Details

I. General information

NPI: 1538197231
Provider Name (Legal Business Name): BANNER LASSEN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SPRING RIDGE DR
SUSANVILLE CA
96130-6100
US

IV. Provider business mailing address

2901 N CENTRAL AVE
PHOENIX AZ
85012-2700
US

V. Phone/Fax

Practice location:
  • Phone: 530-252-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2300000020
License Number StateCA

VIII. Authorized Official

Name: SANDRA DUGGER
Title or Position: CEO
Credential:
Phone: 530-252-2000