1518996040 NPI number — AMERICAN HOSPITAL MANAGEMENT CORPORATION

Table of content: (NPI 1518996040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518996040 NPI number — AMERICAN HOSPITAL MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HOSPITAL MANAGEMENT CORPORATION
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:
MAD RIVER COMMUNITY HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1518996040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCATA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95518-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-822-3621
Provider Business Mailing Address Fax Number:
707-826-8258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 JANES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-3621
Provider Business Practice Location Address Fax Number:
707-826-8258
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
707-822-7220

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  110000031 , 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: HSP40028F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC1209Z . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZR00028F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05-0028 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05U028 . This is a "MEDICARE SWING BED #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HST00028F . This is a "MEDI-CAL SWING BED #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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