NPIMap

Organization Active NPI

Lucerne Community Clinic

  • Rural Health Clinic/Center
  • Lucerne, CA
National Provider Identifier
1376609198
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LUCERNE COMMUNITY CLINIC
Practice address
6300 E. Hwy 20
Lucerne, CA 95458
Phone
(707) 274-9299
Fax
(707) 274-9297
NPI assigned
Dec 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Dr. Robert William Gardner, M.D.
Title
Medical Director
Phone
(707) 274-9299

Specialties & licenses 1

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

Addresses

Primary practice location

6300 E. Hwy 20
Lucerne, CA 95458

Mailing address

PO Box 1978
Lucerne, CA 95458-1978
Phone (707) 274-9299

Other identifiers 1

IdentifierTypeStateIssuer
RHM53967FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Dr Gardner Outpatient Program4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1376609198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "LUCERNE",
            "state": "CA",
            "postal_code": "954581978",
            "telephone_number": "707-274-9299",
            "fax_number": "707-274-9297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 E. HWY 20",
            "city": "LUCERNE",
            "state": "CA",
            "postal_code": "95458",
            "telephone_number": "707-274-9299",
            "fax_number": "707-274-9297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCERNE COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "707-274-9299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53967F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lucerne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.