Provider Demographics
NPI:1467538520
Name:BAKERSFIELD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BAKERSFIELD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BOENING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-327-1792
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-1888
Mailing Address - Country:US
Mailing Address - Phone:661-327-4647
Mailing Address - Fax:661-637-0529
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-4647
Practice Address - Fax:661-637-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000181282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40036FMedicaid
CA90006Medicaid
ZZZA1502ZOtherBLUE SHIELD OF CALIF
CAZZT30036FMedicaid
=========OtherIRS
CA90006Medicaid
CA90006Medicaid
CAZZT30036FMedicaid
CA555607Medicare Oscar/Certification