Provider Demographics
NPI:1619098829
Name:SEQUOIA FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:SEQUOIA FAMILY MEDICAL CENTER
Other - Org Name:LINDSAY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-562-9395
Mailing Address - Street 1:973 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1426
Mailing Address - Country:US
Mailing Address - Phone:559-562-9395
Mailing Address - Fax:559-781-4350
Practice Address - Street 1:590 W PUTNAM AVE # 2A
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
Practice Address - Country:US
Practice Address - Phone:559-781-4100
Practice Address - Fax:559-781-4350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOIA FAMILY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-03
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ02973Z261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08919FMedicaid
CA058919Medicare Oscar/Certification
CAZZ02973ZMedicare ID - Type UnspecifiedMEDICARE