Provider Demographics
NPI:1356344758
Name:WEST COUNTY HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:WEST COUNTY HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-271-7052
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-1446
Mailing Address - Country:US
Mailing Address - Phone:707-869-2849
Mailing Address - Fax:707-869-1477
Practice Address - Street 1:16387 FIRST ST
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446
Practice Address - Country:US
Practice Address - Phone:707-869-2849
Practice Address - Fax:707-869-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAXXXXXXX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03887FMedicaid
CAZZZ73222ZOtherBLUE SHIELD PIN
CAHAP03887FOtherFPACT
CAZZZ73222ZOtherBLUE SHIELD PIN
551839Medicare Oscar/Certification