NPIMap

Organization Active NPI

Marin Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Greenbrae, CA
National Provider Identifier
1669690079
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARIN COMMUNITY CLINIC
Practice address
250 Bon Air Rd
Greenbrae, CA 94904-1702
Phone
(415) 448-1500
Fax
(415) 798-3180
NPI assigned
Apr 23, 2007
Last updated
Jun 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

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

Authorized official

Name
Ms. Kathy Cruz
Title
Medical Staff Coordinator
Phone
(415) 448-1579

Specialties & licenses 1

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

Addresses

Primary practice location

250 Bon Air Rd
Greenbrae, CA 94904-1702

Mailing address

6090 Redwood Blvd
Suite G
Novato, CA 94945-4569
Phone (415) 448-1500

Other identifiers 1

IdentifierTypeStateIssuer
EAP11975FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Marin Community Clinic16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

6090 Redwood Blvd
Ste G
Novato, CA 94945
Phone (415) 798-3106

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1669690079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6090 REDWOOD BLVD",
            "address_2": "SUITE G",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454569",
            "telephone_number": "415-448-1500",
            "fax_number": "415-798-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BON AIR RD",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949041702",
            "telephone_number": "415-448-1500",
            "fax_number": "415-798-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "MEDICAL STAFF COORDINATOR",
        "authorized_official_telephone_number": "415-448-1579",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP11975F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; 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.