Provider Demographics
NPI:1861409823
Name:EL CENTRO REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:EL CENTRO REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT FINANCIAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BENAVIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-482-5334
Mailing Address - Street 1:1415 W ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-339-7495
Mailing Address - Fax:760-352-7612
Practice Address - Street 1:1415 W ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-339-7495
Practice Address - Fax:760-352-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30045FMedicaid
ZZZC1303ZOtherBLUE SHIELD
050045OtherBLUE CROSS
CAZZT40045FMedicaid
CA050045Medicare PIN
CA050045Medicare Oscar/Certification
CAB5026BMedicare PIN