Provider Demographics
NPI:1346381415
Name:OAK VALLEY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:OAK VALLEY HOSPITAL DISTRICT
Other - Org Name:OAK VALLEY DISTRICT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSKREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-848-4104
Mailing Address - Street 1:350 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3519
Mailing Address - Country:US
Mailing Address - Phone:209-847-3011
Mailing Address - Fax:209-848-7008
Practice Address - Street 1:350 S OAK AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3519
Practice Address - Country:US
Practice Address - Phone:209-847-3011
Practice Address - Fax:209-848-4110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK VALLEY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000069282N00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZC5008ZOtherBLUE SHIELD INSURANCE
CAMTE00178FMedicaid
CAZZR00067FMedicaid
CAHSC00067FMedicaid
CAHSP40067FMedicaid
CAZZZC5008ZOtherBLUE SHIELD INSURANCE
CAZZR00067FMedicaid
CA=========953610006OtherTRICARE PROVIDER NUMBER
CAZZZC5008ZOtherBLUE SHIELD INSURANCE
CA=========OtherIRS TAX ID NUMBER
CAZZZ30265ZMedicare PIN