1467506634 NPI number — SIERRA KINGS WOMEN'S HEALTH CENTER, INC. A CALIFORNIA PROFESSIONAL MED

Table of content: (NPI 1467506634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467506634 NPI number — SIERRA KINGS WOMEN'S HEALTH CENTER, INC. A CALIFORNIA PROFESSIONAL MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA KINGS WOMEN'S HEALTH CENTER, INC. A CALIFORNIA PROFESSIONAL MED
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1467506634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93654-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-493-5307
Provider Business Mailing Address Fax Number:
559-553-6269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
372 W CYPRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93654-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-493-5307
Provider Business Practice Location Address Fax Number:
559-553-6269
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
559-493-5307

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G75797 , 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: GR0085541 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0085540 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".