Provider Demographics
NPI:1689746208
Name:BAUTISTA RURAL MEDICAL CLINICS, INC.
Entity Type:Organization
Organization Name:BAUTISTA RURAL MEDICAL CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-875-3428
Mailing Address - Street 1:2570 JENSEN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2269
Mailing Address - Country:US
Mailing Address - Phone:559-875-3428
Mailing Address - Fax:559-875-3434
Practice Address - Street 1:2570 JENSEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2269
Practice Address - Country:US
Practice Address - Phone:559-875-3428
Practice Address - Fax:559-875-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COA432930207R00000X
CAPA 13143363A00000X
CAPA21266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53933FMedicaid
CABZ069AOtherMEDICARE PTAN / PALMETTO
CA00A432930Medicare PIN
CARHM53933FMedicaid
CA553933Medicare ID - Type UnspecifiedRIVERBEND