Provider Demographics
NPI:1235303306
Name:CLOVIS COMMUNITY MEDICAL CENTER
Entity Type:Organization
Organization Name:CLOVIS COMMUNITY MEDICAL CENTER
Other - Org Name:CLOVIS COMMUNITY EKG
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-324-4884
Mailing Address - Street 1:2755 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6800
Mailing Address - Country:US
Mailing Address - Phone:559-459-1672
Mailing Address - Fax:559-459-1058
Practice Address - Street 1:2755 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6800
Practice Address - Country:US
Practice Address - Phone:559-459-1672
Practice Address - Fax:559-459-1058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000004282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92532ZMedicare PIN