1609038751 NPI number — KAWEAH DELTA HEALTH CARE DISTRICT

Table of content: (NPI 1609038751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609038751 NPI number — KAWEAH DELTA HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAWEAH DELTA HEALTH CARE 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:
KAWEAH HEALTH SOUTH CAMPUS PHARMACY
Provider Other Organization Name Type Code:
5
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:
1609038751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W MINERAL KING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-6237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1633 S COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93277-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-624-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TUPPER
Authorized Official First Name:
MALINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SRVP CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
559-624-4065

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  HPE46596 , 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: PHB342090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com