Provider Demographics
NPI:1528016987
Name:SEQUOIA FAMILY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:SEQUOIA FAMILY MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:F
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-781-4100
Mailing Address - Street 1:590 W PUTNAM AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3257
Mailing Address - Country:US
Mailing Address - Phone:559-781-4100
Mailing Address - Fax:559-781-4350
Practice Address - Street 1:590 W PUTNAM AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
Practice Address - Country:US
Practice Address - Phone:559-781-4100
Practice Address - Fax:559-781-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM53820F261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53820FMedicaid
CA553820Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC