MEDICARE: COMMUNITY MEDICAL CENTERS

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCP99999	OTHER	CA	BCCCP

General Provider Information

NPI Number	:	1396918835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 779
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95201-0779
Country	:	US
Telephone Number	:	209-373-2828
Fax Number	:	209-373-2878

Provider Business Practice Location Address
First Line	:	2003 E MARIPOSA RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-7735
Country	:	US
Telephone Number	:	209-751-1900
Fax Number	:	209-751-1950

Authorized Official
Title or Position	:	CFO
Name	:	MR. PAUL B WANDEL
Credential	:
Telephone Number	:	209-373-2828

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2008

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Directions to “COMMUNITY MEDICAL CENTERS ” Practice Location

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