Provider Demographics
NPI:1689938086
Name:CENTRAL COAST HEALTH CARE, INC.
Entity type:Organization
Organization Name:CENTRAL COAST HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:9700 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5569
Mailing Address - Country:US
Mailing Address - Phone:805-461-9000
Mailing Address - Fax:805-461-9001
Practice Address - Street 1:9700 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5569
Practice Address - Country:US
Practice Address - Phone:805-461-9000
Practice Address - Fax:805-461-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty