Basic Information
| Provider Information | |||||||||
| NPI: | 1265646152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAYERS MEMORIAL HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 459 | ||||||||
| Address2: | 43563 STATE HIGHWAY 299 EAST | ||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303365511 | ||||||||
| FaxNumber: | 5303366199 | ||||||||
| Practice Location | |||||||||
| Address1: | 43563 STATE HIGHWAY 299 EAST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303365511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
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| 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 | 3336L0003X | CA | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | PHB307240 | 01 | CA | MEDI-CAL | OTHER |