1881688554 NPI number — SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA 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 1881688554 NPI number — SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA 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:
1881688554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93456-1699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-928-1115
Provider Business Mailing Address Fax Number:
805-928-1276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 CARMEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93458-7729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-928-1115
Provider Business Practice Location Address Fax Number:
805-928-1276
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAGATTUTA
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-928-1115

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  050000561 , 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: 184399000 . This is a "USDL PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7399463 . This is a "AETNA HEALTH PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050000561 . This is a "DPH SURGICAL CLINIC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00305321 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5544477 . This is a "CCN FIRST HEALTH PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CLN 1070 . This is a "DCA BOARD OF PHARMACY CLINIC PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FNP 32177 . This is a "CA MEDICAL BOARD FICTITIOUS NAME PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 21163 . This is a "CITY OF SANTA MARIA BUSINESS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05-C0001539 . This is a "DHS MEDI-CAL CERTIFICATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 212471 . This is a "WA STATE DOL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: C2179691 . This is a "SECRETARY OF STATE CORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SUR01539F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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