Healthcare Provider Details

I. General information

NPI: 1285912956
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COTTAGE AVE STE 103
MANTECA CA
95336-4935
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-624-5800
  • Fax: 209-624-5801
Mailing address:
  • Phone: 209-373-2838
  • Fax: 209-373-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number550000238
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL KIRKPATRICK
Title or Position: CEO
Credential:
Phone: 209-373-2833