1346537396 NPI number — ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, 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 1346537396 NPI number — ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, 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:
1346537396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 ADAMS ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SAINT HELENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94574-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-968-2809
Provider Business Mailing Address Fax Number:
707-963-9185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 N FORBES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95453-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-263-6346
Provider Business Practice Location Address Fax Number:
707-263-5927
Provider Enumeration Date:
06/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DONNELLY
Authorized Official First Name:
KAYE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
SPECIALIST, CONTRACT COMPLIANCE
Authorized Official Telephone Number:
707-968-2809

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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