1073519443 NPI number — PIONEERS MEMORIAL HEALTHCARE DISTRICT

Table of content: (NPI 1073519443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073519443 NPI number — PIONEERS MEMORIAL HEALTHCARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEERS MEMORIAL HEALTHCARE DISTRICT
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:
1073519443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 W LEGION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAWLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92227-7780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-351-3590
Provider Business Mailing Address Fax Number:
760-351-3312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 W LEGION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAWLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92227-7780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-351-3590
Provider Business Practice Location Address Fax Number:
760-351-3312
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CHIEF OPERATION OFFICER
Authorized Official Telephone Number:
760-351-3550

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , 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: 039487 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: A6816 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050342 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZT30342F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050342B000000 . This is a "CMS 1011 PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 131561105 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4105270 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC1301Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3161908 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1509782 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1716235 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP3327 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 021709 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201112200 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZT40342F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com