MEDICARE: COMMUNITY MEDICAL CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	0300000561	CA

General Provider Information

NPI Number	:	1306984315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL CENTERS, INC

Provider Business Mailing Address
First Line	:	PO BOX 779
Second Line	:	7210 MURRAY DRIVE
City	:	STOCKTON
State	:	CA
Zip	:	95210-3339
Country	:	US
Telephone Number	:	209-373-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 E MARIPOSA RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-7735
Country	:	US
Telephone Number	:	209-751-1910
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CHRISTINE C NOGUERA
Credential	:
Telephone Number	:	209-373-2826

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	01/12/2015

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