Provider Demographics
NPI:1528072527
Name:TIPTON MEDICAL CLINIC
Entity type:Organization
Organization Name:TIPTON MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-757-4147
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:CA
Mailing Address - Zip Code:93272-0130
Mailing Address - Country:US
Mailing Address - Phone:559-752-4147
Mailing Address - Fax:559-752-4150
Practice Address - Street 1:565 N THOMPSON RD
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:CA
Practice Address - Zip Code:93272-9756
Practice Address - Country:US
Practice Address - Phone:559-752-4147
Practice Address - Fax:559-752-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM53969F261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528072527Medicaid
CA1BZZZ06823ZOtherBLUE SHIELD
CARHM53969FMedicaid
CAHAP53969FMedicaid
CAHAP53969FMedicaid
CAHAP53969FMedicaid