Provider Demographics
NPI:1588837025
Name:COMMUNITY MEDICAL CENTERS
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-373-2828
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-0779
Mailing Address - Country:US
Mailing Address - Phone:209-373-2828
Mailing Address - Fax:209-373-2878
Practice Address - Street 1:2003 E MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-7735
Practice Address - Country:US
Practice Address - Phone:209-751-1900
Practice Address - Fax:209-751-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFP99999OtherFAMILY PLANNING