Provider Demographics
NPI:1073519443
Name:PIONEERS MEMORIAL HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:PIONEERS MEMORIAL HEALTHCARE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-351-3550
Mailing Address - Street 1:207 W LEGION RD
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-7780
Mailing Address - Country:US
Mailing Address - Phone:760-351-3590
Mailing Address - Fax:760-351-3312
Practice Address - Street 1:207 W LEGION RD
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7780
Practice Address - Country:US
Practice Address - Phone:760-351-3590
Practice Address - Fax:760-351-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR039487Medicaid
NMA6816Medicaid
050342OtherBLUE CROSS
CAZZT30342FMedicaid
CA050342B000000OtherCMS 1011 PROGRAM
AK131561105Medicaid
MT4105270Medicaid
ZZZC1301ZOtherBLUE SHIELD
WA3161908Medicaid
NY1509782Medicaid
TX1716235Medicaid
CACP3327OtherMEDICARE RAILROAD
AZ021709Medicaid
201112200OtherUS DEPT OF LABOR
CAZZT40342FMedicaid
ZZZC1301ZOtherBLUE SHIELD
UT=========001Medicaid
AK131561105Medicaid