Provider Demographics
NPI:1093138604
Name:CENTRAL COAST FAMILY CARE MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CENTRAL COAST FAMILY CARE MEDICAL ASSOCIATES, INC
Other - Org Name:GROUP NPI
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-925-1009
Mailing Address - Street 1:821 E CHAPEL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4618
Mailing Address - Country:US
Mailing Address - Phone:805-925-1009
Mailing Address - Fax:805-925-1137
Practice Address - Street 1:821 E CHAPEL ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4618
Practice Address - Country:US
Practice Address - Phone:805-925-1009
Practice Address - Fax:805-925-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14182BMedicare PIN
CAW14182Medicare PIN
CAW14182EMedicare PIN
CAW14182DMedicare PIN
CAW14182CMedicare PIN
CAW14182AMedicare PIN