1053427302 NPI number — LOS BANOS COMMUNITY HOSPITAL

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 1053427302 NPI number — LOS BANOS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS BANOS COMMUNITY 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:
MEMORIAL HOSPITAL LOS BANOS
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:
1053427302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1870
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95353-1870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-569-7734
Provider Business Mailing Address Fax Number:
209-569-7772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 I ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS BANOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93635-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-826-0591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYDA
Authorized Official First Name:
STAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CENTRAL BUSINESS OFFICE
Authorized Official Telephone Number:
209-572-7172

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  040000177 , 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: RHM13998F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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