Dos Palos Memorial Hospital, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

261QR1300X Issued in CA

Legal business name

DOS PALOS MEMORIAL HOSPITAL, INC

Practice address

2118 Marguerite St
Dos Palos, CA 93620-2339

Phone

(209) 392-6121

Fax

(209) 392-6881

NPI assigned

Jun 1, 2005

Last updated

Mar 15, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ray E Smith

Title

Administrator

Phone

(209) 392-6121

Specialties & licenses 2

Addresses

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 1295737401. Details of each certification follow.

• CCN 050497 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 050497

Legal name

DOS PALOS MEMORIAL HOSPITAL

Certification status

Terminated Involuntary: failure to meet health/safety requirements, Jun 24, 2006

Provider type (POS)

Hospital – Short-term

Participating since

Jun 1, 1969

Last certification

Mar 20, 2006

Beds

17

Ownership / control type

Private (for profit)

Facility address

2118 Marguerite St
Dos Palos, CA 93620

Locations

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331769600000",
    "number": "1295737401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2118 MARGUERITE ST",
            "city": "DOS PALOS",
            "state": "CA",
            "postal_code": "936202339",
            "telephone_number": "209-392-6121",
            "fax_number": "209-392-6881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2118 MARGUERITE ST",
            "city": "DOS PALOS",
            "state": "CA",
            "postal_code": "936202339",
            "telephone_number": "209-392-6121",
            "fax_number": "209-392-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOS PALOS MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2012-03-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-392-6121",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "261QR1300X",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "314000000X",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Randall Barsamian, RPH
• Robert Allen Bertelli, RPH
• Lety Elizabeth Costa, MD
• Dos Palos Apex Health Center Inc
• Dos Palos-Oro Loma Jusd
• Chester Flakes Jr.
• Elizabeth Fonseca
• Alice Ruth Foster-Smith, FNP/PNP
• Golden Valley Health Center

• Clinic/Center in Dos Palos, CA
• Providers in Dos Palos, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.