Provider Demographics
NPI:1164662094
Name:COUNTY OF MADERA
Entity Type:Organization
Organization Name:COUNTY OF MADERA
Other - Org Name:MADERA COUNTY PUBLIC HEALTH LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-675-7893
Mailing Address - Street 1:1604 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-4926
Mailing Address - Country:US
Mailing Address - Phone:559-675-7893
Mailing Address - Fax:559-661-5192
Practice Address - Street 1:1604 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-4926
Practice Address - Country:US
Practice Address - Phone:559-675-7893
Practice Address - Fax:559-661-5192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MADERA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
CA0768291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0711439OtherCLIA