Provider Demographics
NPI:1073739025
Name:CENTRAL COAST HEALTHCARE, A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:CENTRAL COAST HEALTHCARE, A PROFESSIONAL MEDICAL CORP
Other - Org Name:CENTRAL COAST HEALTH CARE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-461-9000
Mailing Address - Street 1:9700 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5571
Mailing Address - Country:US
Mailing Address - Phone:805-461-9000
Mailing Address - Fax:805-461-9001
Practice Address - Street 1:9700 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5571
Practice Address - Country:US
Practice Address - Phone:805-461-9000
Practice Address - Fax:805-461-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care