Provider Demographics
NPI:1093854838
Name:TULARE LOCAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:TULARE LOCAL HEALTH CARE DISTRICT
Other - Org Name:TUALRE DISTRICT HOSPITAL MOBILE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-685-3462
Mailing Address - Street 1:869 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2207
Mailing Address - Country:US
Mailing Address - Phone:559-684-4520
Mailing Address - Fax:559-686-1020
Practice Address - Street 1:14640 AVE 168
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9264
Practice Address - Country:US
Practice Address - Phone:559-684-4520
Practice Address - Fax:559-686-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000585261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40359FMedicaid
CA05-8579Medicare UPIN