Organization
MATHIESEN MEMORIAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE KISS (CREDENTIALING)
(254) 760-0228
Entity
Organization
Contact information
Practice address
18144 SECO ST, JAMESTOWN, CA 95327-9737
(209) 984-4820
(209) 984-4825
Mailing address
PO BOX 535, JAMESTOWN, CA 95327-0535
(209) 984-4820
(209) 984-4825
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
07/16/2008
Last updated
07/25/2023
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