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General NPI Number Information
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NPI Number | 1881685964
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL CENTERS, INC.
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 2401 W TURNER RD
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City | LODI
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State | CA
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Zip | 95242-2182
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Country | US
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Telephone | 209-370-1700
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Fax | 209-370-1737
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Provider Business Mailing Address
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Address Line | PO BOX 779
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City | STOCKTON
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State | CA
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Zip | 95201-0779
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Country | US
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Telephone | 209-373-2800
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Fax | 209-373-2878
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL H KIRKPATRICK
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Credential |
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Telephone | 209-373-2833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 030000424
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License Number State | CA
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