1881688554 NPI number — SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA INC

Table of content: (NPI 1881688554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881688554 NPI number — SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA 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:
1881688554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93456-1699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-928-1115
Provider Business Mailing Address Fax Number:
805-928-1276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 CARMEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93458-7729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-928-1115
Provider Business Practice Location Address Fax Number:
805-928-1276
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAGATTUTA
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-928-1115

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  050000561 , 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: 184399000 . This is a "USDL PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7399463 . This is a "AETNA HEALTH PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050000561 . This is a "DPH SURGICAL CLINIC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00305321 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5544477 . This is a "CCN FIRST HEALTH PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CLN 1070 . This is a "DCA BOARD OF PHARMACY CLINIC PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FNP 32177 . This is a "CA MEDICAL BOARD FICTITIOUS NAME PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 21163 . This is a "CITY OF SANTA MARIA BUSINESS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05-C0001539 . This is a "DHS MEDI-CAL CERTIFICATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 212471 . This is a "WA STATE DOL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: C2179691 . This is a "SECRETARY OF STATE CORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SUR01539F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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