Basic Information
| Provider Information | |||||||||
| NPI: | 1619098829 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEQUOIA FAMILY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LINDSAY URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 973 SEQUOIA AVE | ||||||||
| Address2: | |||||||||
| City: | LINDSAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932471426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595629395 | ||||||||
| FaxNumber: | 5597814350 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 W PUTNAM AVE # 2A | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597814100 | ||||||||
| FaxNumber: | 5597814350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIDHU | ||||||||
| AuthorizedOfficialFirstName: | JASVIR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5595629395 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SEQUOIA FAMILY MEDICAL CENTER | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | ZZZ02973Z | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | RHM08919F | 05 | CA | MEDICAID |