Golden Valley Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Merced, CA
NPI 1114901121 · NPPES record last updated Feb 9, 2017
Key facts
- NPI
- 1114901121
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 040000550 (CA)
- Legal business name
- GOLDEN VALLEY HEALTH CENTER
- Practice address
- 401 Lesher Dr
Merced, CA 95341-6572 - Phone
- (209) 381-4114
- Fax
- (209) 381-4117
- NPI assigned
- Dec 2, 2005
- Organization subpart
- No
Authorized official
- Name
- Tony Weber
- Title
- Ceo
- Phone
- (209) 384-6493
Other NPIs on the same Medicare enrollment 45
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040128000641 | CA | Part B Supplier - Clinic/Group Practice | 4183527187 |
Receives reassigned benefits from 494 practitioners 45 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Modesto, CA; Manteca, CA; Newman, CA; Patterson, CA; Planada, CA; Riverbank, CA; Turlock, CA; Westley, CA… |
National Provider Directory
Locations
401 Lesher Dr
Merced, CA 95341
Phone (209) 381-4114
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 040000550 | CA | Yes |
Addresses
Primary practice location
401 Lesher Dr
Merced, CA 95341-6572
Mailing address
737 W Childs Ave
Merced, CA 95341-6805
Phone (209) 384-6493
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040000550 | Other | CA | STATE OF CA LIC# |
| CMM70998F | Medicaid | CA |
Other providers in Merced, CA
- Golden State Care PC
- Golden State Care PC
- Golden State Health Care Inc.
- Golden State Health Care Inc.
- Golden State Hearing Aid Center Inc.
- Golden Valley Health Center
- Golden Valley Health Center
- Golden Valley Health Center
- Golden Valley Health Center
- Golden Valley Health Center
All providers in Merced, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.