Healthcare Provider Details

I. General information

NPI: 1881887446
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E CHANNEL ST
STOCKTON CA
95202-2628
US

IV. Provider business mailing address

PO BOX 779
STOCKTON CA
95201-0779
US

V. Phone/Fax

Practice location:
  • Phone: 209-373-2828
  • Fax: 209-373-2878
Mailing address:
  • Phone: 209-373-2828
  • Fax: 209-373-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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