Basic Information
| Provider Information | |||||||||
| NPI: | 1497836613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | COMMUNITY DIALYSIS CENTER-CLOVIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 N. MEDICAL CENTER DRIVE EAST | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593244030 | ||||||||
| FaxNumber: | 5593243748 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N. MEDICAL CENTER DRIVE EAST | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593244030 | ||||||||
| FaxNumber: | 5593243748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CASTRO | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | STANLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5593244884 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY REGIONAL MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 040000096 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.