NPIMap

Organization Active NPI

Imperial Beach Community Clinic

  • Family Medicine Physician
  • Imperial Beach, CA
National Provider Identifier
1508028200
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IMPERIAL BEACH COMMUNITY CLINIC
Practice address
949 Palm Avenue
Imperial Beach, CA 91932-1503
Phone
(619) 429-3733
Fax
(619) 429-6457
NPI assigned
Jun 25, 2008
Organization subpart
Yes
Parent organization
IMPERIAL BEACH COMMUNITY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Constance Kirk
Title
Executive Director
Phone
(619) 429-5387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X CA Primary

Addresses

Primary practice location

949 Palm Avenue
Imperial Beach, CA 91932-1503

Mailing address

PO Box 459
Imperial Beach, CA 91933-0459
Phone (619) 429-5387

Other names 1

  • Imperial Beach Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Imperial BCH Comm CL2 organizations share this tax ID, including this one
Part of
Imperial BCH Comm CL

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1508028200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919330459",
            "telephone_number": "619-429-5387",
            "fax_number": "619-429-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 PALM AVENUE",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919321503",
            "telephone_number": "619-429-3733",
            "fax_number": "619-429-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL BEACH COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMPERIAL BEACH COMMUNITY CLINIC",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "619-429-5387"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imperial Beach Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Imperial Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.