NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Multi-Specialty Clinic/Center
  • San Jose, CA
National Provider Identifier
1629236500
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
070000118 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
602 E Santa Clara St
Suite 230
San Jose, CA 95112-1908
Phone
(408) 445-3400
Fax
(408) 448-1041
NPI assigned
May 28, 2008
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Wanda E Edmo
Title
Human Resource Director
Phone
(408) 445-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 070000118 CA Primary

Addresses

Primary practice location

602 E Santa Clara St
Suite 230
San Jose, CA 95112-1908

Mailing address

1333 Meridian Ave
San Jose, CA 95125-5212
Phone (408) 445-3400

Other practice location 1

1118 Meridian Ave Ste 100
San Jose, CA 95125-4351
Phone (408) 445-3400

Other identifiers 2

IdentifierTypeStateIssuer
FHC11833FOtherCAMEDICAL
EAP11833FOtherCAEAPC

National Provider Directory

National Provider Directory
Tax ID family
Indian Health Ctr SC14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

1118 Meridian Ave
Ste 100
San Jose, CA 95125

602 E Santa Clara St
Ste 230
San Jose, CA 95112

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1629236500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255212",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 E SANTA CLARA ST",
            "address_2": "SUITE 230",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951121908",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1118 Meridian Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951254351",
            "country_code": "US",
            "telephone_number": "408-445-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-28",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "EDMO",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "HUMAN RESOURCE DIRECTOR",
        "authorized_official_telephone_number": "408-445-3400"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "070000118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "FHC11833F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP11833F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.