1588822068 NPI number — DIGNITY HEALTH

Table of content: (NPI 1588822068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588822068 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:
ST. JOHN'S HOSPITAL OUTPATIENT LAB
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:
1588822068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 ANTONIO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-1459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-988-7090
Provider Business Mailing Address Fax Number:
805-981-7399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 N ROSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-988-7090
Provider Business Practice Location Address Fax Number:
805-981-7399
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WARDWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
805-225-6121

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 1206 , 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: ZZT40082G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC5602Z . This is a "BSCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62660 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373930300000 . This is a "WPS/TRICARE - GENERAL ACUTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373E . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373930300002 . This is a "WPS/TRICARE - REHAB" identifier . This identifiers is of the category "OTHER".




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