Provider Demographics
NPI:1548399736
Name:DOCTORS MEDICAL CENTER OF MODESTO, INC.
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER OF MODESTO, INC.
Other - Org Name:DOCTORS BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-576-3790
Mailing Address - Street 1:PO BOX 57376
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 CLAUS RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9711
Practice Address - Country:US
Practice Address - Phone:209-558-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS MEDICAL CENTER OF MODESTO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40464HMedicaid
CA5036Medicaid
CAHSC30464HMedicaid
ZZZ20934ZMedicare PIN
CA5036Medicaid