Provider Demographics
NPI:1659317295
Name:HI CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:HI CARE MEDICAL CENTER
Other - Org Name:RANCHO CORDOVA COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-638-5572
Mailing Address - Street 1:2001 ZINFANDEL DR
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4265
Mailing Address - Country:US
Mailing Address - Phone:916-638-5572
Mailing Address - Fax:916-638-5538
Practice Address - Street 1:2001 ZINFANDEL DR
Practice Address - Street 2:SUITE B-3
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4265
Practice Address - Country:US
Practice Address - Phone:916-638-5572
Practice Address - Fax:916-638-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29122207Q00000X
CAC32503207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC32503OtherSTATE LICENSE NUMBER
CAC32503OtherSTATE LICENSE NUMBER
CAA88967Medicare UPIN