Basic Information
| Provider Information | |||||||||
| NPI: | 1629167457 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF VENTURA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | VENTURA COUNTY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S VICTORIA AVE # 4640 | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930094615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 HILLMONT AVE | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056526000 | ||||||||
| FaxNumber: | 8056489561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FOLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8056775272 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0206X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography | 261QU0200X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QF0050X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | 261QI0500X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 261QM0801X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QE0002X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 261QM0850X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM1300X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QM2500X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 261QP0905X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local | 261QP2000X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QP2300X | 050000032 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 282N00000X | 050000032 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 3004405 | 05 | WA | MEDICAID | HSC39008W | 05 | CA | MEDICAID | ZZT49008F | 05 | CA | MEDICAID | ZZT39008F | 05 | CA | MEDICAID | GR0072000 | 05 | CA | MEDICAID | LAB58856F | 05 | CA | MEDICAID | ZZT39008W | 05 | CA | MEDICAID | 025553 | 05 | AZ | MEDICAID | LAB01063F | 05 | CA | MEDICAID | 05S159 | 01 | CA | MENTAL HEALTH IN- PATIENT | OTHER | HSC39008F | 05 | CA | MEDICAID | HSD39008F | 05 | CA | MEDICAID | ZZT49004F | 05 | CA | MEDICAID | 187047 | 05 | OR | MEDICAID | GR0072001 | 05 | CA | MEDICAID |