Basic Information
| Provider Information | |||||||||
| NPI: | 1336167550 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REEDLEY COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ADVENTIST HEALTH REEDLEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 888806 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900888806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596388155 | ||||||||
| FaxNumber: | 5596377555 | ||||||||
| Practice Location | |||||||||
| Address1: | 372 W. CYPRESS AVE | ||||||||
| Address2: | |||||||||
| City: | REEDLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936542113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596388155 | ||||||||
| FaxNumber: | 5596377555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAYDOCK | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5595370050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVENTIST HEALTH SYSTEM/WEST | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 40000149 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | CGP168088 | 05 | CA | MEDICAID | ZZR00192F | 05 | CA | MEDICAID | IP-ZZR00192F | 01 | CA | MEDICAL INPATIENT | OTHER | ZZZ92646Z | 01 | CA | PROFESSIONAL FEES | OTHER | HSP40192F | 05 | CA | MEDICAID | OP-HSP40192F | 01 | CA | MEDI-CAL OUTPATIENT | OTHER | ZZZC1008Z | 01 | CA | BLUE SHIELD PROVIDER NO | OTHER | HAP18540F | 05 | CA | MEDICAID |