Provider Demographics
NPI:1003908484
Name:BIG SUR HEALTH CENTER
Entity Type:Organization
Organization Name:BIG SUR HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:831-667-2580
Mailing Address - Street 1:46896 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:BIG SUR
Mailing Address - State:CA
Mailing Address - Zip Code:93920-9693
Mailing Address - Country:US
Mailing Address - Phone:831-667-2580
Mailing Address - Fax:831-667-0184
Practice Address - Street 1:46896 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BIG SUR
Practice Address - State:CA
Practice Address - Zip Code:93920-9693
Practice Address - Country:US
Practice Address - Phone:831-667-2580
Practice Address - Fax:831-667-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000483261QH0100X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA070000483OtherSTATE CLINIC LICENSE
CACMM70332FMedicaid
ZZZ171502Medicare ID - Type Unspecified