Organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Active
Parent organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Other names
Indian Health Center of Santa Clara Valley - Family Medicine Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Authorized official
DR. ALDON WAYNE SCOTT D. M. (DIRECTOR OF OPERATIONS)
(408) 445-3400
Entity
Organization
Contact information
Practice address
455 OCONNOR DR STE 200, SAN JOSE, CA 95128-1632
(408) 445-3400
(408) 448-1727
Mailing address
1333 MERIDIAN AVE, SAN JOSE, CA 95125-5212
(408) 445-3400
(408) 448-1727
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550001941
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1137
MEDICARE PALMETTO
CA
01
—
FHC11833F
STATE PROGRAMS
CA
05
—
FHC11833F
—
CA
01
—
G01133-01
DELTA DENTAL
CA
Enumeration date
02/13/2012
Last updated
02/07/2013
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