Provider Demographics
NPI:1902851066
Name:PIERCE & RIOS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PIERCE & RIOS MEDICAL CORPORATION
Other - Org Name:MEDICOS UNIDOS DE HURON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLPHUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:559-905-9000
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0189
Mailing Address - Country:US
Mailing Address - Phone:559-945-9000
Mailing Address - Fax:559-945-9009
Practice Address - Street 1:36618 SOUTH LASSEN POB 1269
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234
Practice Address - Country:US
Practice Address - Phone:559-945-9000
Practice Address - Fax:559-945-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM08905F261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08905FMedicaid
CARHM08905FMedicaid