NPIMap

Organization Active NPI

Mayers Memorial Hospital District

  • Community/Retail Pharmacy
  • Fall River Mills, CA
National Provider Identifier
1194296665
Registry record updated Dec 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MAYERS MEMORIAL HOSPITAL DISTRICT
Practice address
43471 State Highway 299 E
Fall River Mills, CA 96028-9777
Phone
(530) 336-7512
NPI assigned
Dec 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2018

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

Authorized official

Name
Travis Howard Lakey
Title
Cfo
Phone
(530) 336-7512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

43471 State Highway 299 E
Fall River Mills, CA 96028-9777

Mailing address

PO Box 459
Fall River Mills, CA 96028-0459
Phone (530) 336-7512

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190812003575 CA Part B Supplier - Pharmacy 6305804196 Practice locations: Fall River Mills, CA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Fall River Mills Fire7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mayers Memorial Hospital DistrictFall River Mills, CA, CCN 051305 Hospital Other (100%) Oct 3, 1969
Mayers Memorial Hospital DistrictFall River Mills, CA, CCN 05Z305 Hospital Operational/Managerial Control (100%) Feb 11, 2015
Mayers Memorial Hospital DistrictFall River Mills, CA, CCN 056416 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Trustee of the SNF
Adp of the SNF		 Oct 2, 1969
Oct 2, 1969
Oct 2, 1969
Oct 2, 1969
Intermountain HospiceFall River Mills, CA, CCN 051738 Hospice Operational/Managerial Control (100%) Jan 1, 1999
Mayers Memorial Hospital DistrictBurney, CA, CCN 058721 Rural health clinic Other Oct 3, 1969

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1194296665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "FALL RIVER MILLS",
            "state": "CA",
            "postal_code": "960280459",
            "telephone_number": "530-336-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43471 STATE HIGHWAY 299 E",
            "city": "FALL RIVER MILLS",
            "state": "CA",
            "postal_code": "960289777",
            "telephone_number": "530-336-7512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYERS MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "LAKEY",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "530-336-7512"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fall River Mills, CA

Sources for this page

Verify at the official NPI Registry.