1104981661 NPI number — DIGNITY HEALTH

Table of content: (NPI 1104981661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104981661 NPI number — DIGNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH
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:
MERCY HOSPITAL
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:
1104981661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93302-0119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-632-5504
Provider Business Mailing Address Fax Number:
661-632-2592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 TRUXTUN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-632-5504
Provider Business Practice Location Address Fax Number:
661-632-2592
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANTU
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
661-632-5296

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  120000184 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 120000184 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40002 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT05044G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40295G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870692237 . This is a "I.R.S." identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA1501Z . This is a "BLUE SHIELD OF CALIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870692237933010000 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZT30295G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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