ST. JUDE MOBILE HEALTH CLINIC 1 – NPI #1386869907
Clinic/Center

ST. JUDE MOBILE HEALTH CLINIC 1 is an AHC clinic located in FULLERTON, CA. NPPES has assigned the NPI number 1386869907 to ST. JUDE MOBILE HEALTH CLINIC 1 on April 17, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “ST. JUDE MOBILE HEALTH CLINIC 1” is a dba name, the actual legal business name for this organization is ST. JUDE HOSPITAL, INC.. The primary taxonomy selected by this provider is 261QP2300X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Primary Care

The NPI profile was previously updated about 18 years ago on Feb 27, 2008. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ST. JUDE MOBILE HEALTH CLINIC 1 below.

NPI Profile for
ST. JUDE HOSPITAL, INC.

NPI Number
1386869907
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ST. JUDE HOSPITAL, INC.
Doing Business As (dba): ST. JUDE MOBILE HEALTH CLINIC 1
Primary location
731 SOUTH HIGHLAND AVENUE
FULLERTON, CA 92832
Phone: (714) 446-5100 Fax:
Mailing address
Same as primary location
Organization Subpart
Yes - ST. JUDE MOBILE HEALTH CLINIC 1 is subpart of another organization.
Authorized Official
BARRY ROSS
VICE PRESIDENT, HEALTHY COMMUNITIES
Phone: (714) 992-3164
Updated
Identifiers

Identifiers for ST. JUDE MOBILE HEALTH CLINIC 1

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDCACMM70906F
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QP2300X
- Clinic/Center / Primary Care (Primary)		 CA 70906F

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.