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NPI Code Detail

MEDICARE: COALINGA MEDICAL CENTER, LLC

MEDICARE: COALINGA MEDICAL CENTER, LLC
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
1174200000XMeals Provider

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184655052
Entity Type Code : Organization
Provider Name (Legal Business Name) : COALINGA MEDICAL CENTER, LLC
Provider Business Mailing Address
First Line : 700 17TH ST STE 205
Second Line :
City : MODESTO
State : CA
Zip : 95354-1249
Country : US
Telephone Number : 209-287-6308
Fax Number : 209-248-7825
Provider Business Practice Location Address
First Line : 1191 PHELPS AVE
Second Line :
City : COALINGA
State : CA
Zip : 93210-9609
Country : US
Telephone Number : 559-935-6562
Fax Number : 559-935-6596
Authorized Official
Title or Position : EXECUTIVE VP/CFO
Name : TAMMY JEAN THOMPSON
Credential :
Telephone Number : 209-287-6308
Provider Enumeration Date : 07/06/2006
Last Update Date : 01/25/2022

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Directions to “COALINGA MEDICAL CENTER, LLC ” Practice Location

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