Healthcare Provider Details

I. General information

NPI: 1225156375
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 CENTRAL AVE
TRACY CA
95376-4104
US

IV. Provider business mailing address

PO BOX 779
STOCKTON CA
95201-0779
US

V. Phone/Fax

Practice location:
  • Phone: 209-870-1500
  • Fax:
Mailing address:
  • Phone: 209-373-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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