PRODIGY HEALTHCARE, INC. (NPI# 1306142484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306142484 |
| Entity Type | Organization |
| Organization Name | PRODIGY HEALTHCARE, INC. |
| Practice Address |
1600 16th St (mo, 1-19,25-31,40) Firebaugh CA 93622-2407 |
| Mailing Address |
Po Box 820 Fowler CA 93625-0820 |
| Practice Telephone | 8888855580 |
| Practice Fax Number | 8888855580 |
| Mailing Telephone | 8888855580 |
| Mailing Fax Number | 8888855580 |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |
| Authorized Official Name | MS. CHRISTINE NICOLE HOWLAND (VICE PRESIDENT) |
| Authorized Official Telephone | 8888855580 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | Y |
| Parent Organization Name | PRODIGY HEALTHCARE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDI-CAL | PENDING | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154718401 | Prodigy Healthcare, Inc. | Clinic/Center | 1 Tiller Ave., Caruthers, CA 93609 | 2015-04-23 |
| 1518354869 | Prodigy Healthcare, Inc. | Clinic/Center | 13620 S. Kincaid, Caruthers, CA 93609 | 2015-04-23 |
| 1144617176 | Prodigy Healthcare, Inc. | Clinic/Center | 2580 W Tahoe Ave, Caruthers, CA 93609-9475 | 2015-04-16 |
| 1972800340 | Prodigy Healthcare, Inc. | Clinic/Center | 701 E Walter Ave, (rooms C10 and C11), Fowler, CA 93625-9792 | 2011-02-22 |
| 1245537612 | Prodigy Healthcare, Inc. | Clinic/Center | 975 East Adams Avenue, (rooms 1-5,offices 1-3), Fowler, CA 93625 | 2011-02-22 |
| 1689970766 | Prodigy Healthcare, Inc. | Clinic/Center | 1191 P St, (mo, Rooms 1-20), Firebaugh, CA 93622-2230 | 2011-02-07 |
| 1134425200 | Prodigy Healthcare, Inc. | Clinic/Center | 1666 Saipan Ave, (rooms 1-8), Firebaugh, CA 93622-2438 | 2011-02-07 |
| 1710284229 | Prodigy Healthcare, Inc. | Clinic/Center | 701 E Main St, (rooms 104, 501, 701), Fowler, CA 93625-2423 | 2011-02-17 |
| 1316243546 | Prodigy Healthcare, Inc. | Clinic/Center | 1976 Morris Kyle Dr, (mo,101-2,301-5,404,501-5,601-5,701-3,801-14,901-7,co), Firebaugh, CA 93622-9711 | 2011-02-05 |
| 1497051627 | Prodigy Healthcare, Inc. | Clinic/Center | 311 E Merced St, (rooms 1-7, Conference Room ), Fowler, CA 93625-2316 | 2011-02-05 |
| Street Address |
1600 16TH ST (MO, 1-19,25-31,40) |
| City | FIREBAUGH |
| State | CA |
| Zip Code | 93622-2407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558638601 | Valley Health Team, Inc. | Clinic/Center | 927 O St, Firebaugh, CA 93622 | 2011-11-17 |
| 1932307485 | Maritess Garcia Fuentes | Family Medicine | 927 O St, Firebaugh, CA 93622-2220 | 2007-07-06 |
| 1710973060 | Oscar Mangarero Sablan | Internal Medicine | 979 O St, Ste B, Firebaugh, CA 93622-2220 | 2005-09-22 |
| 1386057354 | Amandeep Kaur Kahal | Family Medicine | 927 O St, Firebaugh, CA 93622-2220 | 2014-06-08 |
| 1477992584 | Diana Oviedo-cavazos | Family Medicine | 927 O St, Firebaugh, CA 93622-2220 | 2013-06-21 |
| 1295051571 | Satnam Singh Bangar | Family Medicine | 927 O St, Firebaugh, CA 93622-2220 | 2010-04-13 |
| 1568679397 | Sablan Medical Corporation | Family Medicine | 979 O St, Ste B, Firebaugh, CA 93622-2220 | 2007-05-17 |
| 1649266990 | Marcia Eckelman Sablan | Family Medicine | 979 O St, Ste B, Firebaugh, CA 93622-2220 | 2005-09-22 |
| 1386798338 | Evelyn Aguilera Kramer | Physician Assistant | 992 O St, Firebaugh, CA 93622-2221 | 2007-01-23 |
| 1053344259 | Patrick Doucette | Dentist | 910 O St, Firebaugh, CA 93622-2221 | 2006-07-09 |
| Find all providers in zip 93622 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689970766 | Prodigy Healthcare, Inc. | Clinic/Center | 1191 P St, (mo, Rooms 1-20), Firebaugh, CA 93622-2230 | 2011-02-07 |
| 1134425200 | Prodigy Healthcare, Inc. | Clinic/Center | 1666 Saipan Ave, (rooms 1-8), Firebaugh, CA 93622-2438 | 2011-02-07 |
| 1316243546 | Prodigy Healthcare, Inc. | Clinic/Center | 1976 Morris Kyle Dr, (mo,101-2,301-5,404,501-5,601-5,701-3,801-14,901-7,co), Firebaugh, CA 93622-9711 | 2011-02-05 |
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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.