Provider Demographics
NPI:1225367840
Name:CHOWCHILLA MEMORIAL HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:CHOWCHILLA MEMORIAL HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-665-3781
Mailing Address - Street 1:1200 VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-2246
Mailing Address - Country:US
Mailing Address - Phone:559-665-3781
Mailing Address - Fax:559-665-7195
Practice Address - Street 1:1200 VENTURA AVE
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2246
Practice Address - Country:US
Practice Address - Phone:559-665-3781
Practice Address - Fax:559-665-7195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOWCHILLA DISTRICT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000252261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555530Medicare PIN