Mid Valley Health Services Long Term Care Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PHY49880 Issued in CA

Legal business name

MID VALLEY HEALTH SERVICES LONG TERM CARE INC

Doing business as

MID VALLEY HEALTH SERVICES LONG TERM CARE

Practice address

602 Scenic Dr
Modesto, CA 95350-6128

Phone

(209) 552-7600

Fax

(209) 552-7638

NPI assigned

May 1, 2008

Organization subpart

No

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

Authorized official

Name

Harold Stoll

Title

Coo

Phone

(209) 552-7600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MID VALLEY HEALTH SERVICES LONG TERM CARE Doing business as

Locations

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1760658553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506128",
            "telephone_number": "209-552-7600",
            "fax_number": "209-552-7638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506128",
            "telephone_number": "209-552-7600",
            "fax_number": "209-552-7638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID VALLEY HEALTH SERVICES LONG TERM CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "STOLL",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "209-552-7600"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "PHY49880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113493",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID VALLEY HEALTH SERVICES LONG TERM CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joan Ann Michelotti, RN
• Adam Michnowski
• Emily Mickschl
• Sarah Mickschl
• Maria Regina Lardizabal Mico
• Eric E Miedema, OD
• Krystle Marie Miguens
• Kelly Jo Mikelson
• Lauren E Miklose
• Kristi Lynn Miklusicak, M.A., B.I.C.M.

• Long Term Care Pharmacy in Modesto, CA
• Providers in Modesto, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; 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.