1215903018 NPI number — COMMUNITY MEMORIAL HEALTH SYSTEM

Table of content: (NPI 1215903018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215903018 NPI number — COMMUNITY MEMORIAL HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MEMORIAL HEALTH SYSTEM
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:
1215903018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 N BRENT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-652-5011
Provider Business Mailing Address Fax Number:
805-585-3007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 N BRENT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-652-5011
Provider Business Practice Location Address Fax Number:
805-585-3007
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZDEBLICK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
805-652-5011

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HSC30394F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM18553H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050394 . This is a "BLUE CROSS PROVIDER NO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ53994Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: RHM08608F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40394F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM08609F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA5603Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 024745500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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