Healthcare Provider Details

I. General information

NPI: 1730318825
Provider Name (Legal Business Name): SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CANAL ST STE. B
KING CITY CA
93930-3461
US

IV. Provider business mailing address

300 CANAL ST
KING CITY CA
93930-3431
US

V. Phone/Fax

Practice location:
  • Phone: 831-385-1280
  • Fax: 831-385-1285
Mailing address:
  • Phone: 831-385-6000
  • Fax: 831-385-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number070000047
License Number StateCA

VIII. Authorized Official

Name: MR. GARY WANGSMO
Title or Position: CFO
Credential:
Phone: 831-385-7160