Healthcare Provider Details

I. General information

NPI: 1336222314
Provider Name (Legal Business Name): KINGSBURG DISTRICT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SMITH ST
KINGSBURG CA
93631-2216
US

IV. Provider business mailing address

1200 SMITH ST
KINGSBURG CA
93631-2216
US

V. Phone/Fax

Practice location:
  • Phone: 559-897-5841
  • Fax: 559-897-5579
Mailing address:
  • Phone: 559-897-5841
  • Fax: 559-897-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number555452
License Number StateCA

VIII. Authorized Official

Name: MR. LUIS SIERRA
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 559-897-5841