=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922334846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANNER LASSEN MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2009
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 SPRING RIDGE DR
-----------------------------------------------------
City | SUSANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96130-6100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-252-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 N 12TH ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85006-2837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SANDRA DUGGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-747-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------