Healthcare Provider Details

I. General information

NPI: 1689349862
Provider Name (Legal Business Name): COALINGA MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 PHELPS AVE
COALINGA CA
93210-9609
US

IV. Provider business mailing address

700 17TH ST STE 205
MODESTO CA
95354-1249
US

V. Phone/Fax

Practice location:
  • Phone: 559-349-0208
  • Fax:
Mailing address:
  • Phone: 209-287-6308
  • Fax:

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: EXECUTIVE VP FINANCE/CFO
Credential:
Phone: 209-287-6308