1659317295 NPI number — HI CARE MEDICAL CENTER

Table of content: (NPI 1659317295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659317295 NPI number — HI CARE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HI CARE MEDICAL CENTER
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:
1659317295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 ZINFANDEL DR
Provider Second Line Business Mailing Address:
SUITE B-3
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-4265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-638-5572
Provider Business Mailing Address Fax Number:
916-638-5538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 ZINFANDEL DR
Provider Second Line Business Practice Location Address:
SUITE B-3
Provider Business Practice Location Address City Name:
RANCHO CORDOVA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95670-4265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-638-5572
Provider Business Practice Location Address Fax Number:
916-638-5538
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PERRY
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
916-638-5572

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  C32503 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A29122 , 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: C32503 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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