MEDICARE: COMMUNITY MEMORIAL HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QU0200X	Urgent Care Clinic/Center
2	261QV0200X	VA Clinic/Center
3	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689612798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEMORIAL HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	5855 OLIVAS PARK DR
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-7672
Country	:	US
Telephone Number	:	805-667-2801
Fax Number	:	805-667-2865

Provider Business Practice Location Address
First Line	:	242 E HARVARD BLVD
Second Line	:	SUITE C
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3372
Country	:	US
Telephone Number	:	805-525-9595
Fax Number	:	805-525-6667

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICK ZDEBLICK
Credential	:
Telephone Number	:	805-652-5011

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	05/28/2024

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Directions to “COMMUNITY MEMORIAL HEALTH SYSTEM ” Practice Location

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