NPIMap

Organization Active NPI

Antelope Valley Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Lancaster, CA
National Provider Identifier
1730499872
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001452 Issued in CA
Legal business name
ANTELOPE VALLEY COMMUNITY CLINIC
Practice address
45104 10TH St W
Lancaster, CA 93534-2310
Phone
(661) 942-2391
Fax
(662) 902-6839
NPI assigned
Oct 7, 2010
Last updated
Jul 6, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
ANTELOPE VALLEY COMMUNITY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Mr. James A Cook
Title
Ceo
Phone
(661) 942-2391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550001452 CA Primary

Addresses

Primary practice location

45104 10TH St W
Lancaster, CA 93534-2310

Mailing address

45074 10TH St W
Suite 109
Lancaster, CA 93534-2371
Phone (661) 942-2391

Other identifiers 1

IdentifierTypeStateIssuer
CT556AOtherCAMEDICARE PTAN

Other names 1

  • ANTELOPE VALLEY COMMUNITY CLINIC HEALTH AND WELLNESS CENTER Other name

National Provider Directory

National Provider Directory
Part of
Antelope Valley Community Clinic

NPI Registry JSON

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

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1730499872",
    "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": "662-902-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "enumeration_date": "2010-10-07",
        "last_updated": "2011-07-06",
        "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."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CT556A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANTELOPE VALLEY COMMUNITY CLINIC HEALTH AND WELLNESS CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.