Provider Demographics
NPI:1609919513
Name:KINGSBURG DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:KINGSBURG DISTRICT HOSPITAL
Other - Org Name:KINGSBURG MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:559-897-5841
Mailing Address - Street 1:1200 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2216
Mailing Address - Country:US
Mailing Address - Phone:559-897-5841
Mailing Address - Fax:559-897-5579
Practice Address - Street 1:1200 SMITH ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2216
Practice Address - Country:US
Practice Address - Phone:559-897-5841
Practice Address - Fax:559-897-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHSP30682G282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH1010ZOtherBLUE SHIELD PIN
CAHSP30682GMedicaid
CA050682Medicare Oscar/Certification