NPIMap

Organization Active NPI

Lba

Doing business as Avenal Medical Clinic

  • Rural Health Clinic/Center
  • Avenal, CA
National Provider Identifier
1205001682
Registry record updated Jun 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
207RN0300X Issued in CA
Legal business name
LBA
Doing business as
Avenal Medical Clinic
Practice address
148 E Kings St
Avenal, CA 93204-1529
Phone
(559) 386-9000
Fax
(559) 386-9090
NPI assigned
Apr 25, 2008
Last updated
Jun 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2014

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

Authorized official

Name
Amy Zachary-Penton, FNP
Title
Administrator
Phone
(805) 441-1310

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 207RN0300X CA Primary

Addresses

Primary practice location

148 E Kings St
Avenal, CA 93204-1529

Mailing address

PO Box 547
Avenal, CA 93204-0547
Phone (559) 386-9000

Other names 1

  • AVENAL MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205001682. Details of each certification follow.

Rural health clinic certification: CCN 058921

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
AVENAL MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 22, 2005
Last certification
Jul 19, 2019
Ownership / control type
2B
Most recent change of ownership
Mar 1, 2011 (1 total)
Facility address
148 East Kings
Avenal, CA 93204

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1205001682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "AVENAL",
            "state": "CA",
            "postal_code": "932040547",
            "telephone_number": "559-386-9000",
            "fax_number": "559-386-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 E KINGS ST",
            "city": "AVENAL",
            "state": "CA",
            "postal_code": "932041529",
            "telephone_number": "559-386-9000",
            "fax_number": "559-386-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LBA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "ZACHARY-PENTON",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "805-441-1310",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "207RN0300X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVENAL MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avenal, CA

Sources for this page

Verify at the official NPI Registry.