1073640918 NPI number — SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.

Table of content: (NPI 1073640918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073640918 NPI number — SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COUNTY COMMUNITY HEALTH CENTER, 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:
6
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:
1073640918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1798 A BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-1611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-330-7400
Provider Business Mailing Address Fax Number:
650-321-1560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 TERMINAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENLO PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94025-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-321-0980
Provider Business Practice Location Address Fax Number:
650-321-0988
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOST
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
650-330-7407

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com