1497836613 NPI number — FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER

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 1497836613 NPI number — FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
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:
COMMUNITY DIALYSIS CENTER-CLOVIS
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:
1497836613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N. MEDICAL CENTER DRIVE EAST
Provider Second Line Business Mailing Address:
SUITE 1100
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-324-4030
Provider Business Mailing Address Fax Number:
559-324-3748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N. MEDICAL CENTER DRIVE EAST
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-324-4030
Provider Business Practice Location Address Fax Number:
559-324-3748
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASTRO
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
STANLEY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
559-324-4884

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  040000096 , 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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