Provider Demographics
NPI:1609856947
Name:HEART HOSPITAL OF BK, LLC
Entity Type:Organization
Organization Name:HEART HOSPITAL OF BK, LLC
Other - Org Name:BAKERSFIELD HEART HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:3001 SILLECT AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6337
Mailing Address - Country:US
Mailing Address - Phone:661-316-6000
Mailing Address - Fax:
Practice Address - Street 1:3001 SILLECT AVENUE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:616-316-6000
Practice Address - Fax:661-316-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000526282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40724FMedicaid
CA050724Medicare Oscar/Certification