Provider Demographics
NPI:1578900148
Name:BAKERSFIELD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BAKERSFIELD MEMORIAL HOSPITAL
Other - Org Name:PREMIER VALLEY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MONCY
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:661-396-7100
Mailing Address - Street 1:10314 STERLING SILVER ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9524
Mailing Address - Country:US
Mailing Address - Phone:661-303-7201
Mailing Address - Fax:
Practice Address - Street 1:5401 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6279
Practice Address - Country:US
Practice Address - Phone:661-396-7100
Practice Address - Fax:661-396-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23810261QP2300X
CA650527282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578900148OtherNATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM