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NPI Code Detail

MEDICARE: COMMUNITY MEDICAL CENTERS, INC

MEDICARE: COMMUNITY MEDICAL CENTERS, 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
1261QF0400XFederally Qualified Health Center (FQHC)030000561CA

Other Identifiers

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

General Provider Information

NPI Number : 1578552543
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY MEDICAL CENTERS, INC
Provider Business Mailing Address
First Line : PO BOX 779
Second Line :
City : STOCKTON
State : CA
Zip : 95201-0779
Country : US
Telephone Number : 209-373-2800
Fax Number : 209-373-2878
Provider Business Practice Location Address
First Line : 701 E CHANNEL ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-2628
Country : US
Telephone Number : 209-944-4700
Fax Number : 209-944-6715
Authorized Official
Title or Position : CEO
Name : MR. MICHAEL H KIRKPATRICK
Credential :
Telephone Number : 209-373-2833
Provider Enumeration Date : 10/20/2005
Last Update Date : 07/14/2010

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1609959576 — KRISTINE C MAKI N.P.
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1245316645 — DR. BENJAMIN BARTLETT MORRISON M. D.
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1992881015 — JAMES T. PARKER M.D.
Practice Location Address:
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Directions to “COMMUNITY MEDICAL CENTERS, INC ” Practice Location

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