Healthcare Provider Details

I. General information

NPI: 1164055034
Provider Name (Legal Business Name): SOUTH COUNTY COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MIRAMONTE AVE FL 2
MOUNTAIN VIEW CA
94040-2457
US

IV. Provider business mailing address

1885 BAY RD
EAST PALO ALTO CA
94303-1312
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-3323
  • Fax: 650-321-1560
Mailing address:
  • Phone: 650-330-7400
  • Fax: 650-321-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRI LYNN THOMAS
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 650-330-7414