1720217151 NPI number — SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1720217151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720217151 NPI number — SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
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:
1720217151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CANAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93930-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-385-6000
Provider Business Mailing Address Fax Number:
831-385-7188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 CANAL ST
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
KING CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93930-3461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-385-7401
Provider Business Practice Location Address Fax Number:
831-386-7402
Provider Enumeration Date:
07/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WANGSMO
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
831-385-7160

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  070000047 , 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: ZZZ54850Y . This is a "BLUE SHIELD - SPECIALTY CLINIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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