1699907436 NPI number — OUTPATIENT AND SPECIALTY CENTER AT SIERRA KINGS DISTRICT HOSPITAL

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 1699907436 NPI number — OUTPATIENT AND SPECIALTY CENTER AT SIERRA KINGS DISTRICT HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTPATIENT AND SPECIALTY CENTER AT SIERRA KINGS DISTRICT 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:
SIERRA KINGS HEALTH CARE DISTRICT
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:
1699907436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 W. CYPRESS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93654-2113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-638-8155
Provider Business Mailing Address Fax Number:
559-638-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
372 W CYPRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93654-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-638-8155
Provider Business Practice Location Address Fax Number:
559-638-7555
Provider Enumeration Date:
08/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OTT
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
559-638-8155

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  APPLIED FOR/PENDING , 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: APPLIED FOR/PENDING , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: APPLIED FOR/PENDING . This is a "MEDICARE, TYPE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".




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