Mountain Health & Community Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

550000543 Issued in CA

Legal business name

MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.

Practice address

316 25TH St
San Diego, CA 92102-3016

Phone

(619) 238-5551

Fax

(619) 238-3807

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Judith Shaplin

Title

Ceo

Phone

(619) 445-6200

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• 25th Street Family Medicine Doing business as

Locations

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494201600000",
    "number": "1861603151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31115 HIGHWAY 94",
            "city": "CAMPO",
            "state": "CA",
            "postal_code": "919063133",
            "telephone_number": "619-478-5254",
            "fax_number": "619-478-9164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 25TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921023016",
            "telephone_number": "619-238-5551",
            "fax_number": "619-238-3807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2017-05-08",
        "status": "A",
        "authorized_official_last_name": "SHAPLIN",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-445-6200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAM",
            "identifier": "BCP71185F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71185F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAM",
            "identifier": "HAP71185F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "25th Street Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Mouck, AUD
• Michael V Mouet
• Brandie Moulton
• Lia Moulton
• Mountain Health & Community Services, Inc.
• Kelvin Mountain, D.C.
• Leo Mountain, ND
• Michael K Mountain, D.C.
• Alexander Mounts
• Guilherme Moura Da Cunha, MD

• Federally Qualified Health Center (FQHC) in San Diego, CA
• Providers in San Diego, 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 May 8, 2017; 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.