Provider Demographics
NPI:1316317068
Name:MARIPOSA COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:MARIPOSA COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SERGIENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:209-966-3689
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0005
Mailing Address - Country:US
Mailing Address - Phone:209-966-3689
Mailing Address - Fax:209-966-4929
Practice Address - Street 1:5085 BULLION ST.
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-3689
Practice Address - Fax:209-966-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508907064Medicare PIN