Provider Demographics
NPI:1629094891
Name:COUNTY OF STANISLAUS
Entity type:Organization
Organization Name:COUNTY OF STANISLAUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-558-7163
Mailing Address - Street 1:830 SCENIC DR
Mailing Address - Street 2:MODESTO, CA SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:209-558-7000
Mailing Address - Fax:
Practice Address - Street 1:830 SCENIC DR
Practice Address - Street 2:MODESTO, CA SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-558-7000
Practice Address - Fax:209-558-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70751FOtherMEDICAL PROVIDER NUMBER
CALAB10463FOtherMEDICAL
CACMM70760FOtherMEDICAL PROVIDER NUMBER
CAGR0081280OtherMEDICAL GROUP PROVIDER N.
CARHM18531FOtherMEDICAL PROVIDER NUMBER
CAHAP18531FOtherMEDICAL
CE0652OtherMEDICARE RAILROAD
CACMM70753FOtherMEDICAL PROVIDER NUMBER
CACMM70762FOtherMEDICAL PROVIDER NUMBER
CABCP18531FOtherBCEDP
CACMM70759FOtherMEDICAL PROVIDER NUMBER
CAZZR11501FOtherMEDICAL PROVIDER NUMBER
CACMM70757FOtherMEDICAL PROVIDER NUMBER
CACMM70758FOtherMEDICAL PROVIDER NUMBER
CAEXE70074FOtherMEDICAL PROVIDER NUMBER
CAGR0081280OtherMEDICAL GROUP PROVIDER N.
CAEXE70074FOtherMEDICAL PROVIDER NUMBER
CAHAP18531FOtherMEDICAL