1790743466 NPI number — PRIMARY CRITICAL CARE LIMITED PARTNERSHIP

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 1790743466 NPI number — PRIMARY CRITICAL CARE LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CRITICAL CARE LIMITED PARTNERSHIP
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:
1790743466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 998
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91603-0998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-509-2222
Provider Business Mailing Address Fax Number:
818-761-3458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 DELBON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95382-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-667-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIPE
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT AND GENERAL PARTNER
Authorized Official Telephone Number:
818-509-2222

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G42382 , 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: GR0088734 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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