Provider Demographics
NPI:1386955433
Name:SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-385-7160
Mailing Address - Street 1:400 CANAL ST
Mailing Address - Street 2:STE B
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3461
Mailing Address - Country:US
Mailing Address - Phone:831-386-7401
Mailing Address - Fax:831-386-7402
Practice Address - Street 1:400 CANAL ST
Practice Address - Street 2:STE B
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3461
Practice Address - Country:US
Practice Address - Phone:831-386-7401
Practice Address - Fax:831-386-7402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-23
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000047261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54850YOtherBLUE SHIELD PROVIDER #
CAEO941AMedicare PIN