1104067636 NPI number — KAWEAH DELTA HEALTH CARE DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104067636 NPI number — KAWEAH DELTA HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAWEAH DELTA HEALTH CARE DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KAWEAH HEALTH LINDSAY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104067636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W MINERAL KING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-6237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-624-2739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
839 SEQUOIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDSAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93247-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-624-2000
Provider Business Practice Location Address Fax Number:
559-713-2356
Provider Enumeration Date:
03/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TUPPER
Authorized Official First Name:
MALINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SRVP/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
559-624-4065

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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