1992736599 NPI number — DOCTORS HOSPITAL OF MANTECA, INC.

Table of content: (NPI 1992736599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992736599 NPI number — DOCTORS HOSPITAL OF MANTECA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS HOSPITAL OF MANTECA, 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:
DOCTORS HOSPITAL OF MANTECA
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:
1992736599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57435
Provider Second Line Business Mailing Address:
FILE 57435
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-7435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-578-2513
Provider Business Mailing Address Fax Number:
209-239-8329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 E NORTH ST
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:
95336-4932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-823-3111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARRISON
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
209-823-8362

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  030000203 , 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: ZZZC3910Z . This is a "BS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC00118G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163607300 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005073-0001 . This is a "PACIFICARE OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZR00118G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000413 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP40118G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC30118G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40118H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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