Provider Demographics
NPI:1891837878
Name:KINGSBURG DISTRICT HOSPITAL
Entity type:Organization
Organization Name:KINGSBURG DISTRICT HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:559-897-5841
Mailing Address - Street 1:1200 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2216
Mailing Address - Country:US
Mailing Address - Phone:559-897-5841
Mailing Address - Fax:559-897-5579
Practice Address - Street 1:1200 SMITH ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2216
Practice Address - Country:US
Practice Address - Phone:559-897-5841
Practice Address - Fax:559-897-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM13995FMedicaid
CAZZZ61298ZOtherBLUE SHIELD PIN
CA053995Medicare Oscar/Certification