Provider Demographics
NPI:1699766519
Name:COMMUNITY MEDICAL CENTERS, INC
Entity type:Organization
Organization Name:COMMUNITY MEDICAL CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-373-2831
Mailing Address - Street 1:7210 MURRAY DR
Mailing Address - Street 2:PO BOX 779
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3339
Mailing Address - Country:US
Mailing Address - Phone:209-373-2800
Mailing Address - Fax:209-373-2878
Practice Address - Street 1:131 W A ST STE 1
Practice Address - Street 2:DIXON FAMILY PRACTICE
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3437
Practice Address - Country:US
Practice Address - Phone:707-635-1600
Practice Address - Fax:707-635-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000152261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03864FMedicaid
CA051830Medicare ID - Type Unspecified