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Southern Monterey County Memorial Hospital

Organization Active NPI Clinic/Center · King City, CA

NPI 1386955433 · NPPES record last updated Dec 17, 2014

Key facts

NPI
1386955433
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
License
070000047 (CA)
Legal business name
SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL
Practice address
400 Canal St
Ste B
King City, CA 93930-3461
Phone
(831) 386-7401
Fax
(831) 386-7402
NPI assigned
Jun 23, 2010
Organization subpart
Yes
Parent organization (as reported)
SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL

Authorized official

Name
Mrs. Susan Childers
Title
Cfo
Phone
(831) 385-7160

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 25

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

Practitioners 36

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

View all 36

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2241136Specialty Clinic
400 Canal St Suite B, King City, CA 93930		Certificate of waiverOct 24, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mee Memorial Children'S Health and Wellness Center
King City, CA · CCN 058732		 Rural health clinic Operational/Managerial Control Jan 1, 1966

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110329000913 CA Part B Supplier - Clinic/Group Practice 7719883461 Receives reassigned benefits from 3 practitioners
Practice locations: King City, CA

National Provider Directory

Tax ID family
GL Mee Memorial Hosp Spec (26 organizations share this tax ID)
Part of
GL Mee Memorial Hosp Spec

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 070000047 CA Yes

Addresses

Primary practice location

400 Canal St
Ste B
King City, CA 93930-3461

Mailing address

400 Canal St
Ste B
King City, CA 93930-3461
Phone (831) 386-7401

Other identifiers

IdentifierTypeStateIssuer
ZZZ54850YOtherCABLUE SHIELD PROVIDER #

Other names

  • G. L. Mee Memorial Hospital Specialty Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 17, 2014.

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1386955433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CANAL ST",
            "address_2": "STE B",
            "city": "KING CITY",
            "state": "CA",
            "postal_code": "939303461",
            "telephone_number": "831-386-7401",
            "fax_number": "831-386-7402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CANAL ST",
            "address_2": "STE B",
            "city": "KING CITY",
            "state": "CA",
            "postal_code": "939303461",
            "telephone_number": "831-386-7401",
            "fax_number": "831-386-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2010-06-23",
        "last_updated": "2014-12-17",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "831-385-7160",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "070000047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "ZZZ54850Y",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "G. L. Mee Memorial Hospital Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in King City, CA

All providers in King City, CA · Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.