1457621922 NPI number — COMMUNITY MEDICAL CENTERS, INC.

Table of content: (NPI 1457621922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457621922 NPI number — COMMUNITY MEDICAL CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MEDICAL CENTERS, 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:
1457621922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7210 MURRAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95210-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-373-2800
Provider Business Mailing Address Fax Number:
209-373-2879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 COTTAGE AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95336-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-624-5800
Provider Business Practice Location Address Fax Number:
209-624-5801
Provider Enumeration Date:
12/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BAGALAYOS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
209-373-2838

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  550000238 , 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: 1710211214 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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