1174503114 NPI number — MADERA COMMUNITY HOSPITAL

Table of content: (NPI 1174503114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174503114 NPI number — MADERA COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADERA COMMUNITY HOSPITAL
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:
FAMILY HEALTH SERVICES RURAL HEALTH CLINIC
Provider Other Organization Name Type Code:
5
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:
1174503114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 E ALMOND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADERA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93637-5606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-675-5555
Provider Business Mailing Address Fax Number:
559-675-5509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 E ALMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADERA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93637-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-675-5530
Provider Business Practice Location Address Fax Number:
559-675-5532
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOOTE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
VP-FINANCE/CFO
Authorized Official Telephone Number:
559-675-5505

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  040000191 , 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)

  • Identifier: RHM13990F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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