1013024132 NPI number — IMGRX SJ VALLEY, INC.

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 1013024132 NPI number — IMGRX SJ VALLEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMGRX SJ VALLEY, 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:
UNITED HEALTH CENTERS PARLIER
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:
1013024132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ATTN: CHC RETAIL PHARMACY DEPT. 13651 DUBLIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-749-4000
Provider Business Mailing Address Fax Number:
614-652-0326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
429 E MANNING AVE BLDG 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARLIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93648-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-646-3561
Provider Business Practice Location Address Fax Number:
559-646-6916
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, MANAGED SERVICES
Authorized Official Telephone Number:
281-749-4764

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 54519 , 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: PHA198030 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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