Basic Information
| Provider Information | |||||||||
| NPI: | 1326167115 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEQUOIA FAMILY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LINDSAY FAMILY & PEDIATRIC CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 825 SEQUOIA AVE | ||||||||
| Address2: | |||||||||
| City: | LINDSAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932471424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597814100 | ||||||||
| FaxNumber: | 5597814350 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 SEQUOIA AVE | ||||||||
| Address2: | |||||||||
| City: | LINDSAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932471424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597814100 | ||||||||
| FaxNumber: | 5597814350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GILES | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5597814100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 058918 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 058918 | 05 | CA | MEDICAID |