Provider Demographics
NPI:1306981758
Name:JOHN PRIVETT
Entity type:Organization
Organization Name:JOHN PRIVETT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:PRIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-322-1496
Mailing Address - Street 1:2001 WESTWIND DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3034
Mailing Address - Country:US
Mailing Address - Phone:661-322-1496
Mailing Address - Fax:661-322-7151
Practice Address - Street 1:2001 WESTWIND DR
Practice Address - Street 2:SUITE 15
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3034
Practice Address - Country:US
Practice Address - Phone:661-322-1496
Practice Address - Fax:661-322-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADME01573G332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01573GMedicaid
CA$$$$$$$$$OtherSOCIAL SECURITY NUMBER
CA0600410001Medicare NSC