Provider Demographics
NPI:1578064846
Name:COLUSA MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:COLUSA MEDICAL CENTER, LLC
Other - Org Name:COLUSA HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-248-7851
Mailing Address - Street 1:700 17TH ST STE 201D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2949
Practice Address - Country:US
Practice Address - Phone:530-619-0800
Practice Address - Fax:530-619-0297
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUSA MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-22
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health