Basic Information
| Provider Information | |||||||||
| NPI: | 1043203276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAYERS MEMORIAL HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 459 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303365511 | ||||||||
| FaxNumber: | 5303366199 | ||||||||
| Practice Location | |||||||||
| Address1: | 43563 STATE HIGHWAY 299 E | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960289787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303365511 | ||||||||
| FaxNumber: | 5303366996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 05/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | REES | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5303365511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | HPE30724 | CA | N | Suppliers | Pharmacy | 282N00000X | 230000021 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSP40406G | 01 | MEDI-CAL | OTHER | PHB307210 | 05 | CA | MEDICAID | LTC06416F | 01 | MEDI-CAL | OTHER | ZZR00406G | 05 | CA | MEDICAID |