1083613921 NPI number — COUNTY OF TUOLUMNE

Table of content: (NPI 1083613921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083613921 NPI number — COUNTY OF TUOLUMNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF TUOLUMNE
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:
1083613921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5024
Provider Second Line Business Mailing Address:
18440 STRIKER COURT
Provider Business Mailing Address City Name:
SONORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95370-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-533-7368
Provider Business Mailing Address Fax Number:
209-533-5726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18440 STRIKER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-7555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-7368
Provider Business Practice Location Address Fax Number:
209-533-5726
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAINS
Authorized Official First Name:
GERALDINE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
FISCAL SUPERVISOR
Authorized Official Telephone Number:
209-533-7368

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590004033 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MTE00259F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP133315 . This is a "CALIF. CHILDRENS SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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