Provider Demographics
NPI:1164055034
Name:SOUTH COUNTY COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:SOUTH COUNTY COMMUNITY HEALTH CENTER INC
Other - Org Name:MAYVIEW COMMUNITY HEALTH CENTER MOUNTAIN VIEW A MEMBER OF RFHN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-330-7414
Mailing Address - Street 1:1885 BAY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1312
Mailing Address - Country:US
Mailing Address - Phone:650-330-7400
Mailing Address - Fax:650-321-1560
Practice Address - Street 1:900 MIRAMONTE AVE FL 2
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2457
Practice Address - Country:US
Practice Address - Phone:650-965-3323
Practice Address - Fax:650-321-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care