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NPI Code Detail

MEDICARE: GOLDEN VALLEY HEALTH CENTER

MEDICARE: GOLDEN VALLEY HEALTH CENTER
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)030000528CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ZZZ52522ZOTHERCABLUE SHIELD OF CA GRP PIN
3030000528OTHERCASTATE OF CA LIC#

General Provider Information

NPI Number : 1780668863
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDEN VALLEY HEALTH CENTER
Provider Business Mailing Address
First Line : 737 W CHILDS AVE
Second Line :
City : MERCED
State : CA
Zip : 95341-6805
Country : US
Telephone Number : 209-384-6493
Fax Number : 209-383-1296
Provider Business Practice Location Address
First Line : 1717 LAS VEGAS ST
Second Line :
City : MODESTO
State : CA
Zip : 95358-5500
Country : US
Telephone Number : 209-476-4200
Fax Number : 209-556-5064
Authorized Official
Title or Position : CEO
Name : MR. TONY WEBER
Credential :
Telephone Number : 209-384-6493
Provider Enumeration Date : 12/02/2005
Last Update Date : 02/09/2017

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Directions to “GOLDEN VALLEY HEALTH CENTER ” Practice Location

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