NPIMap

Organization Active NPI

Community Memorial Health System

  • Multi-Specialty Clinic/Center
  • Ventura, CA
National Provider Identifier
1063456903
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COMMUNITY MEMORIAL HEALTH SYSTEM
Practice address
4730 Telephone Rd
Ventura, CA 93003-5210
Phone
(805) 643-1871
Fax
(805) 639-0786
NPI assigned
Jun 15, 2006
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY MEMORIAL HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gary K Wilde
Title
Ceo
Phone
(805) 652-5011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
VA Clinic/Center 261QV0200X NU

Addresses

Primary practice location

4730 Telephone Rd
Ventura, CA 93003-5210

Mailing address

2705 Loma Vista Rd
Suite 205
Ventura, CA 93003-1581
Phone (805) 667-2801

Other identifiers 1

IdentifierTypeStateIssuer
ZZT40394FMedicaidCA

Other names 1

  • CMH Centers for Family Health Other name

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial HLTH22 organizations share this tax ID, including this one
Part of
Community Memorial HLTH

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

4730 Telephone Rd
Ventura, CA 93003
Phone (805) 643-1871

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1063456903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 LOMA VISTA RD",
            "address_2": "SUITE 205",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031581",
            "telephone_number": "805-667-2801",
            "fax_number": "805-667-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 TELEPHONE RD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930035210",
            "telephone_number": "805-643-1871",
            "fax_number": "805-639-0786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY MEMORIAL HEALTH SYSTEM",
        "enumeration_date": "2006-06-15",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "805-652-5011",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT40394F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMH Centers for Family Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ventura, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.