MEDICARE: MEMORAIL HOSPITAL OF LOS BANOS

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	282N00000X	General Acute Care Hospital	040000177	CA
2	282N00000X	General Acute Care Hospital	0400000177	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154302271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORAIL HOSPITAL OF LOS BANOS

Provider Business Mailing Address
First Line	:	PO BOX 740152
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-0152
Country	:	US
Telephone Number	:	855-398-1633
Fax Number	:	209-572-7772

Provider Business Practice Location Address
First Line	:	520 I STREET
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4211
Country	:	US
Telephone Number	:	209-826-0591
Fax Number	:

Authorized Official
Title or Position	:	VP SHARED SERVICES
Name	:	MR. BRIAN TRENT HUNTER
Credential	:
Telephone Number	:	916-297-8555

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/02/2013

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Directions to “MEMORAIL HOSPITAL OF LOS BANOS ” Practice Location

Language	Start Address	Practice Location

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