Provider Demographics
NPI:1548346752
Name:VISALIA MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:VISALIA MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:STRID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-738-7500
Mailing Address - Street 1:5400 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8222
Mailing Address - Country:US
Mailing Address - Phone:559-738-7500
Mailing Address - Fax:559-627-0106
Practice Address - Street 1:5400 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8222
Practice Address - Country:US
Practice Address - Phone:559-738-7500
Practice Address - Fax:559-627-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58720ZMedicare ID - Type UnspecifiedLABORATORY