1780668434 NPI number — HENRY MAYO NEWHALL MEMORIAL HOSPITAL

Table of content: (NPI 1780668434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780668434 NPI number — HENRY MAYO NEWHALL MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY MAYO NEWHALL MEMORIAL HOSPITAL
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:
HENRY MAYO NEWHALL 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:
1780668434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23845 MCBEAN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-253-8000
Provider Business Mailing Address Fax Number:
661-200-1033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23845 MCBEAN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-253-8000
Provider Business Practice Location Address Fax Number:
661-200-1033
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SEAVER
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT AND C.E.O.
Authorized Official Telephone Number:
661-200-1021

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZT40624F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP006630 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30624F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC9929Z . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C0688832 . This is a "CHAMPUS PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30624F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP165127 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010244900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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