Provider Demographics
NPI:1447386024
Name:COUNTY MEDICAL SERVICES PROGRAM GOVERNING BOARD
Entity Type:Organization
Organization Name:COUNTY MEDICAL SERVICES PROGRAM GOVERNING BOARD
Other - Org Name:CMSP GOVERNING BOARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-649-2631
Mailing Address - Street 1:1451 RIVER PARK DR
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4507
Mailing Address - Country:US
Mailing Address - Phone:916-649-2631
Mailing Address - Fax:916-649-2606
Practice Address - Street 1:1451 RIVER PARK DR
Practice Address - Street 2:SUITE 222
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4507
Practice Address - Country:US
Practice Address - Phone:916-649-2631
Practice Address - Fax:916-649-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare