Provider Demographics
NPI:1558726786
Name:COMMUNITY MEDICAL CENTERS, INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTERS, INC
Other - Org Name:COMMUNITY MEDICAL CENTERS, DOROTHY L. JONES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-373-2831
Mailing Address - Street 1:7210 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3339
Mailing Address - Country:US
Mailing Address - Phone:209-373-2800
Mailing Address - Fax:
Practice Address - Street 1:2044 FAIR ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2313
Practice Address - Country:US
Practice Address - Phone:209-944-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751893Medicare Oscar/Certification