Basic Information
| Provider Information | |||||||||
| NPI: | 1245574458 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TULARE LOCAL HEALTH CARE DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KINGSBURG HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 869 N. CHERRY STREET | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932742207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596853462 | ||||||||
| FaxNumber: | 5596853835 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 SMITH STREET | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936312216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598979922 | ||||||||
| FaxNumber: | 5598974958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHIMAMOTO | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5596853462 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 120000585 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.