Healthcare Provider Details

I. General information

NPI: 1952246423
Provider Name (Legal Business Name): COUNTRY MOBILE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24511 W JAYNE AVE
COALINGA CA
93210-9503
US

IV. Provider business mailing address

110 VEREDA CORDILLERA
GOLETA CA
93117-5301
US

V. Phone/Fax

Practice location:
  • Phone: 307-459-1350
  • Fax:
Mailing address:
  • Phone: 307-459-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANITA CHAMBERS
Title or Position: CEO
Credential:
Phone: 650-823-3014