Provider Demographics
NPI:1952568610
Name:TULARE LOCAL HOSPITAL DISTRICT 4858
Entity Type:Organization
Organization Name:TULARE LOCAL HOSPITAL DISTRICT 4858
Other - Org Name:PARA TU SALUD GEM STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-685-3462
Mailing Address - Street 1:570 E TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2184
Mailing Address - Country:US
Mailing Address - Phone:559-684-4520
Mailing Address - Fax:559-686-1020
Practice Address - Street 1:570 E TERRACE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2184
Practice Address - Country:US
Practice Address - Phone:559-684-4520
Practice Address - Fax:559-686-1020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULARE LOCAL HOSPITAL DISTRICT 4858
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-20
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health