Provider Demographics
NPI:1396246633
Name:COLUSA MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:COLUSA MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-287-6308
Mailing Address - Street 1:700 17TH ST STE 201D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 E ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:CA
Practice Address - Zip Code:95987-5810
Practice Address - Country:US
Practice Address - Phone:530-619-0800
Practice Address - Fax:530-619-0897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUSA MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health