Healthcare Provider Details

I. General information

NPI: 1558034165
Provider Name (Legal Business Name): COALINGA MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 01/25/2022
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 PHELPS AVE
COALINGA CA
93210-9609
US

IV. Provider business mailing address

1191 PHELPS AVE
COALINGA CA
93210-9609
US

V. Phone/Fax

Practice location:
  • Phone: 209-287-6308
  • Fax: 209-248-7825
Mailing address:
  • Phone: 209-287-6308
  • Fax: 209-248-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: TAMMY JEAN THOMPSON
Title or Position: VICE PRESIDENT/CHIEF FINANCIAL OFFI
Credential:
Phone: 209-287-6308