MEDICARE: RIDGECREST REGIONAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician
2	282NC0060X	Critical Access Hospital	550002085	CA

General Provider Information

NPI Number	:	1447253125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGECREST REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	1081 N CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3130
Country	:	US
Telephone Number	:	760-446-3551
Fax Number	:	760-499-3014

Provider Business Practice Location Address
First Line	:	1081 N CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3130
Country	:	US
Telephone Number	:	760-446-3551
Fax Number	:	760-499-3014

Authorized Official
Title or Position	:	CEO
Name	:	JAMES SUVER
Credential	:
Telephone Number	:	760-499-3902

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/26/2021

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1336145739 — DR. JUDITH J BURICHIN M.D.
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1932181021 — MS. NANCY ELIZABETH MATTHEWS RN
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1548248776 — DR. JOSEPH TERMINEL EDWARDS MD
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1063480275 — MR. ERIC L FLATEN CRNA
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Directions to “RIDGECREST REGIONAL HOSPITAL ” Practice Location

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