Antelope Valley Community Clinic

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

060000428 Issued in CA

Legal business name

ANTELOPE VALLEY COMMUNITY CLINIC

Doing business as

Antelope Valley Community Clinic - Mobile Health Clinic I

Practice address

45104 10TH St W
Lancaster, CA 93534-2310

Phone

(661) 942-2391

Fax

(661) 902-6839

NPI assigned

May 4, 2007

Last updated

Sep 12, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

ANTELOPE VALLEY COMMUNITY CLINICAs reported in NPPES

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

Authorized official

Name

Mr. James A. Cook, MSW

Title

Ceo

Phone

(661) 942-2391

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Antelope Valley Community Clinic - Mobile Health Clinic I Doing business as

Part of

Lancaster Adult Day Health Care

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1710199674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45074 10TH ST W",
            "address_2": "SUITE 109",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342371",
            "telephone_number": "661-942-2391",
            "fax_number": "661-902-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45104 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342310",
            "telephone_number": "661-942-2391",
            "fax_number": "661-902-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "enumeration_date": "2007-05-04",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-942-2391",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "060000428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "CMM70633H",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CT556A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antelope Valley Community Clinic - Mobile Health Clinic I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Antelope Valley Birth Center
• Antelope Valley Cardiology Associates
• Antelope Valley Community Clinic (Lancaster Adult Day Health Care)
• Antelope Valley Community Clinic (Antelope Valley Community Clinic - Lancaster)
• Antelope Valley Community Clinic (Antelope Valley Community Clinic-Mobile Health Clinic II)
• Antelope Valley Community Clinic
• Antelope Valley Community Clinic
• Antelope Valley Community Clinic
• Antelope Valley Council on Alcoholism and Drug Dependency
• Antelope Valley Dialysis Center Medical Group, Inc

• Federally Qualified Health Center (FQHC) in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; 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.