Provider Demographics
NPI:1518988575
Name:FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Entity Type:Organization
Organization Name:FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Other - Org Name:UNIVERSITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MGR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-459-3578
Mailing Address - Street 1:290 N WAYTE LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2124
Mailing Address - Country:US
Mailing Address - Phone:559-459-4592
Mailing Address - Fax:559-459-6110
Practice Address - Street 1:290 N WAYTE LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-459-4592
Practice Address - Fax:559-459-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
CAPHY419243336C0003X
CAHSP419243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHB195530Medicaid
1992098OtherPK