Basic Information
| Provider Information | |||||||||
| NPI: | 1467538520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAKERSFIELD MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1888 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933031888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613274647 | ||||||||
| FaxNumber: | 6616370529 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 34TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613274647 | ||||||||
| FaxNumber: | 6616370529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | VAN BOENING | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6613271792 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 120000181 | CA | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 282N00000X | 120000181 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZT40036F | 05 | CA | MEDICAID | 90006 | 05 | CA | MEDICAID | ZZZA1502Z | 01 | BLUE SHIELD OF CALIF | OTHER | ZZT30036F | 05 | CA | MEDICAID |