Provider Demographics
NPI:1669730271
Name:ACADEMIC FAMILY MEDICINE CLINIC-MH
Entity type:Organization
Organization Name:ACADEMIC FAMILY MEDICINE CLINIC-MH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF HOSPITAL OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEWEIS-SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-648-9554
Mailing Address - Street 1:133 W SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2543
Mailing Address - Country:US
Mailing Address - Phone:805-641-5745
Mailing Address - Fax:
Practice Address - Street 1:3291 LOMA VISTA RD
Practice Address - Street 2:BUILDING 340
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3099
Practice Address - Country:US
Practice Address - Phone:805-641-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VENTURA COUNTY HEALTH CARE AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-02
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QP2300X, 261QM2500X
CA050000032261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care