MATHIESEN MEMORIAL HEALTH CLINIC (NPI# 1255595484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255595484 |
| Entity Type | Organization |
| Organization Name | MATHIESEN MEMORIAL HEALTH CLINIC |
| Practice Address |
18144 Seco St Jamestown CA 95327-9737 |
| Mailing Address |
Po Box 535 Jamestown CA 95327-0535 |
| Practice Telephone | 2099844820 |
| Practice Fax Number | 2099844825 |
| Mailing Telephone | 2099844820 |
| Mailing Fax Number | 2099844825 |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2012-05-07 |
| Authorized Official Name | MR. WARD (ANDY) ANDERSON (EXEC. DIR.) |
| Authorized Official Telephone | 2066844820 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MATHIESEN MEMORIAL HEALTH CLINIC | 18144 Seco St, Jamestown, CA 95327-9498 |
| Street Address |
18144 SECO ST |
| City | JAMESTOWN |
| State | CA |
| Zip Code | 95327-9737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073714937 | Haku Kevin Kahoano | Family Medicine | 18144 Seco St, Mathiesen Memorial Health Clinic, Jamestown, CA 95327-9737 | 2007-05-29 |
| 1548813017 | Kara Sigler | Registered Nurse | 18144 Seco St, Jamestown, CA 95327-9498 | 2019-07-23 |
| 1881179372 | Alexandra Maria Faria | Physician Assistant | 18144 Seco St, Jamestown, CA 95327-9498 | 2018-10-01 |
| 1952856502 | Weiya Douglas Lu | Registered Nurse | 18144 Seco St, Jamestown, CA 95327-9498 | 2016-08-23 |
| 1750737763 | David Benjamin Demattei | Physician Assistant | 18144 Seco St, Jamestown, CA 95327-9498 | 2016-05-09 |
| 1578961736 | Melissa Ann Ronneburg | Nurse Practitioner | 18144 Seco St, Jamestown, CA 95327-9498 | 2014-12-19 |
| 1235578311 | Dayna Decristoferi | Marriage & Family Therapist | 18144 Seco St, Jamestown, CA 95327-9737 | 2013-06-21 |
| 1497075790 | Ann Radford | Nurse Practitioner | 18144 Seco St, Jamestown, CA 95327-9737 | 2010-06-09 |
| 1336337484 | Gina M Valente-moore | Nurse Practitioner | 18144 Seco St, Jamestown, CA 95327-9737 | 2007-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386985794 | Minou Alexander | Psychologist | 5100 O'byrner Ferry Rd., Sierra Conservation Center, Jamestown, CA 95327 | 2013-03-11 |
| 1871898304 | Corrections and Rehabilitation | Pharmacy | 5100 O'byrnes Ferry Road, Attn: Pharmacy, Jamestown, CA 95327 | 2011-01-13 |
| 1760709935 | Nicole R Stevenson | Dental Assistant | 17922 Shell Road, Jamestown Road, CA 95327 | 2010-04-28 |
| 1326020710 | Russell Dean Park | Psychologist | 5100 O'byrnes Ferry Rd., Jamestown, CA 95327 | 2005-11-19 |
| 1831625102 | Richard Perry Halliburton | Psychologist | 5100 Obyrnes Ferry Rd, Jamestown, CA 95327 | 2017-05-05 |
| 1770690968 | Margaret L. Smith | Registered Nurse | 18189 Seco St., Jamestown, CA 95327-0950 | 2006-08-24 |
| 1932268646 | Michael A Backlund | Psychologist | 5100 O Brynes Ferry Rd, Jamestown, CA 95327-9102 | 2006-12-08 |
| 1255302022 | Blong Roger Ly | Dentist | 5100 Obyrnes Ferry Rd, Jamestown, CA 95327-9102 | 2006-01-30 |
| 1710427778 | Sierra Conservation Center | Clinic/Center | 5100 Obyrnes Ferry Rd, Jamestown, CA 95327-9102 | 2017-02-24 |
| 1659628287 | Gary Collinsworth | Pharmacist | 5100 Obyrnes Ferry Rd, Jamestown, CA 95327-9102 | 2012-08-14 |
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| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.