Provider Demographics
NPI:1164974739
Name:KERN COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:KERN COUNTY HOSPITAL AUTHORITY
Other - Org Name:KERN MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP AMBULATORY CARE
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-326-2682
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:ROOM 1241
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:661-326-2000
Mailing Address - Fax:
Practice Address - Street 1:820 34TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2283
Practice Address - Country:US
Practice Address - Phone:661-326-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 208D00000X
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty