1295737401 NPI number — DOS PALOS MEMORIAL HOSPITAL, INC

Table of content: (NPI 1295737401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295737401 NPI number — DOS PALOS MEMORIAL HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOS PALOS MEMORIAL HOSPITAL, INC
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:
Provider Other Organization Name Type Code:
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:
1295737401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2118 MARGUERITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOS PALOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93620-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-392-6121
Provider Business Mailing Address Fax Number:
209-392-6881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2118 MARGUERITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOS PALOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93620-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-392-6121
Provider Business Practice Location Address Fax Number:
209-392-6881
Provider Enumeration Date:
06/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
RAY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
209-392-6121

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  261QR1300X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 314000000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: LTC55311I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM18598F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".