NPIMap

Organization Active NPI

Antelope Valley Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Palmdale, CA
National Provider Identifier
1346563673
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001129 Issued in CA
Legal business name
ANTELOPE VALLEY COMMUNITY CLINIC
Practice address
2151 E Palmdale Blvd
Palmdale, CA 93550-4037
Phone
(661) 575-0009
Fax
(661) 575-0015
NPI assigned
Mar 1, 2010
Organization subpart
Yes
Parent organization
ANTELOPE VALLEY COMMUNITY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Mr. James A. Cook
Title
Ceo
Phone
(661) 942-2391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550001129 CA Primary

Addresses

Primary practice location

2151 E Palmdale Blvd
Palmdale, CA 93550-4037

Mailing address

45074 10TH Street West
Suite 109
Lancaster, CA 93534-2382
Phone (661) 575-0009

Other identifiers 1

IdentifierTypeStateIssuer
CT556AOtherCAMEDICARE PTAN

Other names 1

  • Antelope Valley Community Clinic-Palmdale Doing business as

National Provider Directory

National Provider Directory
Part of
Lancaster Adult Day Health Care

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1346563673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45074 10TH STREET WEST",
            "address_2": "SUITE 109",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342382",
            "telephone_number": "661-575-0009",
            "fax_number": "661-575-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 E PALMDALE BLVD",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935504037",
            "telephone_number": "661-575-0009",
            "fax_number": "661-575-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "enumeration_date": "2010-03-01",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-942-2391",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CT556A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antelope Valley Community Clinic-Palmdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmdale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.