1598768962 NPI number — WEST COUNTY HEALTH CENTERS, 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 1598768962 NPI number — WEST COUNTY HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COUNTY HEALTH CENTERS, 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:
OCCIDENTAL AREA HEALTH CENTER
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:
1598768962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUERNEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95446-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-874-2444
Provider Business Mailing Address Fax Number:
707-874-1664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3802 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCCIDENTAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-874-2444
Provider Business Practice Location Address Fax Number:
707-874-1664
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
TARI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
707-869-5977

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: HAP03899G . This is a "FPACT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ23666Z . This is a "BLUE SHIELD PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC03899G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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