1689746208 NPI number — BAUTISTA RURAL MEDICAL CLINICS, INC.

Table of content: (NPI 1689746208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689746208 NPI number — BAUTISTA RURAL MEDICAL CLINICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAUTISTA RURAL MEDICAL CLINICS, 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:
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:
1689746208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2570 JENSEN AVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SANGER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93657-2269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-875-3428
Provider Business Mailing Address Fax Number:
559-875-3434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 JENSEN AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SANGER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93657-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-875-3428
Provider Business Practice Location Address Fax Number:
559-875-3434
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESCOBAR
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
559-875-3428

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A432930 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA 13143 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA21266 , 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: RHM53933F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BZ069A . This is a "MEDICARE PTAN / PALMETTO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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