1508175431 NPI number — ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI

Table of content: (NPI 1508175431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508175431 NPI number — ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI
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:
1508175431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 845755
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90084-5755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-771-8600
Provider Business Mailing Address Fax Number:
661-823-1594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2041 BELSHAW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOJAVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93501-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-1622
Provider Business Practice Location Address Fax Number:
661-823-1594
Provider Enumeration Date:
09/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WOLCOTT
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-771-8600

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  120000188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZT30446F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40446F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM08620F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM13979F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC30446F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM13977F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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