Healthcare Provider Details

I. General information

NPI: 1538223375
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E HAMMER LN SUITE A
STOCKTON CA
95210-4116
US

IV. Provider business mailing address

PO BOX 779
STOCKTON CA
95201-0779
US

V. Phone/Fax

Practice location:
  • Phone: 209-751-5200
  • Fax: 209-751-5252
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 Number550000238
License Number StateCA

VIII. Authorized Official

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