Healthcare Provider Details

I. General information

NPI: 1164586772
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 E LAFAYETTE ST
STOCKTON CA
95205-5713
US

IV. Provider business mailing address

P. O. BOX 779 7210 MURRAY DR
STOCKTON CA
95201-0779
US

V. Phone/Fax

Practice location:
  • Phone: 209-933-7232
  • Fax: 209-466-6527
Mailing address:
  • Phone: 209-373-2833
  • Fax: 209-373-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0300000561
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL H. KIRKPATRICK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 209-373-2833