Provider Demographics
NPI:1891720199
Name:HANFORD COMMUNITY MEDICAL CENTER
Entity Type:Organization
Organization Name:HANFORD COMMUNITY MEDICAL CENTER
Other - Org Name:HANFORD REGIONAL HEALTHCARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:559-585-5588
Mailing Address - Street 1:1524 W LACEY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5965
Mailing Address - Country:US
Mailing Address - Phone:559-583-4500
Mailing Address - Fax:559-583-4600
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE 101 - 202
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-583-4697
Practice Address - Fax:559-583-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40121FMedicaid
CAZZT40121FMedicaid