Provider Demographics
NPI:1578081915
Name:KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:KAWEAH DELTA HEALTH CARE DISTRICT
Other - Org Name:KAWEAH HEALTH MEDICAL CLINIC - WILLOW SPECIALTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-4065
Mailing Address - Street 1:400 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6237
Mailing Address - Country:US
Mailing Address - Phone:559-624-2739
Mailing Address - Fax:
Practice Address - Street 1:202 W WILLOW AVE STE 202
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6238
Practice Address - Country:US
Practice Address - Phone:559-624-2739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAWEAH DELTA HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty