Provider Demographics
NPI:1669639324
Name:TULARE LOCAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:TULARE LOCAL HEALTH CARE DISTRICT
Other - Org Name:KINGSBURG HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-685-3462
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:559-897-9922
Mailing Address - Fax:559-897-4958
Practice Address - Street 1:1062 S K ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-6422
Practice Address - Country:US
Practice Address - Phone:559-684-4520
Practice Address - Fax:559-686-1157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULARE LOCAL HEALTHCARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-20
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING261QR1300X
CA120000585261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
058642Medicare PIN