Provider Demographics
NPI:1336389600
Name:SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Other - Org Name:BROADWAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMACHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-385-7284
Mailing Address - Street 1:300 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3431
Mailing Address - Country:US
Mailing Address - Phone:831-386-7437
Mailing Address - Fax:831-385-7188
Practice Address - Street 1:809 BROADWAY ST
Practice Address - Street 2:STE. D
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3303
Practice Address - Country:US
Practice Address - Phone:831-386-7437
Practice Address - Fax:831-385-7188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
CA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health