MEDICARE: COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1124045042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC

Provider Business Mailing Address
First Line	:	2050 S BLOSSER RD
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-7310
Country	:	US
Telephone Number	:	805-361-8028
Fax Number	:	805-361-8097

Provider Business Practice Location Address
First Line	:	416 SPRING ST STE 201
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-3155
Country	:	US
Telephone Number	:	805-238-7250
Fax Number	:	805-238-0165

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RONALD E CASTLE
Credential	:
Telephone Number	:	805-361-8014

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	01/21/2019

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