BANNER LASSEN MEDICAL CENTER (NPI# 1720463961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720463961 |
| Entity Type | Organization |
| Organization Name | BANNER LASSEN MEDICAL CENTER |
| Practice Address |
1800 Spring Ridge Dr Susanville CA 96130-6100 |
| Mailing Address |
2901 N Central Ave Ste 160 Phoenix AZ 85012-2700 |
| Practice Telephone | 5302522000 |
| Practice Fax Number | 5302522241 |
| Mailing Telephone | 6027474000 |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2016-05-05 |
| Authorized Official Name | DENNIS DAHLEN (SR VP FINANCE) |
| Authorized Official Telephone | 6027474000 |
| Is Organization Subpart | Y |
| Parent Organization Name | BANNER HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | HSA | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922334846 | Banner Lassen Medical Center | Medicare Defined Swing Bed Unit | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2009-10-28 |
| 1538197231 | Banner Lassen Medical Center | General Acute Care Hospital | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2006-06-29 |
| Street Address |
1800 SPRING RIDGE DR |
| City | SUSANVILLE |
| State | CA |
| Zip Code | 96130-6100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891768271 | Kirk E Lott | Nurse Anesthetist, Certified Registered | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2006-02-08 |
| 1629421797 | Riaz Medical Group Inc | Family Medicine | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2016-07-13 |
| 1033570247 | Sierra Er Department Physicians Medical Group Inc. | Physician Assistant | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2016-03-15 |
| 1780044735 | Matthew S Mccarty Md Inc | General Acute Care Hospital | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2016-03-03 |
| 1043675739 | Mercy Air Service, Inc. | Ambulance | 1800 Spring Ridge Dr, Susanville, CA 96130 | 2015-12-22 |
| 1750788865 | Northstar Radiology - California | Radiology | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2014-12-04 |
| 1043562002 | California Em-i Medical Services, A Medical Corporation | Physician Assistant | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2012-10-15 |
| 1346599305 | Darlene Amy Dougherty | Dietitian, Registered | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2012-09-06 |
| 1124386719 | Rooptown Emergency Physicians, A Medical Corporation | Emergency Medicine | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2012-05-02 |
| 1881950541 | Banner Health Physicians West LLC | Clinic/Center | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2012-04-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932753456 | Shaughn Randall Whittaker | Nurse Practitioner | 1860 Paul Bunyan Rd, Susanville, CA 96130 | 2019-08-01 |
| 1871980847 | Katie Gaffney | Acupuncturist | 1850 Spring Ridge Dr., Susanville, CA 96130 | 2015-04-17 |
| 1952678435 | Linda Vixie | Dentist | 3020 Johnstonville Rd., Susanville, CA 96130 | 2011-11-28 |
| 1942503057 | Pamela Sue Vallalvazo | Counselor | 1445 Paul Bunyon Rd., Susanville, CA 96130 | 2010-12-10 |
| 1255631883 | Jessica Smyth | Counselor | 1400 Chestnut Street # A, Susanville, CA 96130 | 2010-10-29 |
| 1295045276 | Danielle Hardy | Counselor | 1400 Chestnut Street Suite A, Susanville, CA 96130 | 2010-10-08 |
| 1982921417 | Ronald Spencer Tucker Jr. | Counselor | 4119 Johnstonville Road, #270503, Susanville, CA 96130 | 2010-04-23 |
| 1609107945 | Timothy J Nolan | Psychologist | 803 1/2 Main St., Suite 104, Susanville, CA 96130 | 2010-01-27 |
| 1528243649 | Daniel Martin Bruce | Case Manager/Care Coordinator | 720-a Richmond Road, Susanville, CA 96130 | 2008-01-08 |
| 1679757785 | Michael Charles Giddings | Dentist | 475 Rice Canyon Rd, Susanville, CA 96130 | 2007-12-26 |
| Find all providers in zip 96130 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205267549 | Banner Health | Clinic/Center | 1345 A Paul Bunyan Rd, Susanville, CA 96130-3159 | 2013-12-12 |
| 1881950541 | Banner Health Physicians West LLC | Clinic/Center | 1800 Spring Ridge Dr, Susanville, CA 96130-6100 | 2012-04-06 |
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| Find all providers with the same taxonomy | ||||
| City | SUSANVILLE |
| Zip Code | 96130 |
Please comment or provide details below to improve the information on BANNER LASSEN MEDICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.