KINGS WINERY MEDICLA CLINIC
NPI 1154656254
Exclusive Provider Organization in Fresno, CA

Active since October 07, 2009CLIA 05D0715734 · Microscopy
4929 E KINGS CANYON RD, FRESNO, CA 93727(559) 255-6476(559) 255-7906 Get Directions Write a Review

NPPES record last updated: April 29, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Kings Winery Medicla Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KINGS WINERY MEDICLA CLINIC (NPI 1154656254) is a healthcare organization registered as an exclusive provider organization in Fresno, California and active in the NPI registry since October 2009. The organization holds a CLIA Microscopy certificate valid through August 31, 2026 and lists Bla Mouanoutoua, Ceo, as its authorized official.

NPPES Registry Identity

NPI1154656254
Entity TypeOrganization
Primary Taxonomy302F00000X
Legal Business NameGREATER FRESNO HEALTH ORGNIZATION, INC.
Location Address4929 E KINGS CANYON RDFresno, CA 93727-3812
Mailing Address4929 E Kings Canyon RdFresno, CA 93727-3812 · (559) 255-6476 · Fax (559) 255-7906
Fax(559) 255-7906
Organization SubpartNo
Authorized OfficialBla MouanoutouaCeo · (559) 255-6476
Enumeration DateOctober 7, 2009
Last NPPES UpdateApril 29, 2024
NPPES CertifiedApril 29, 2024
NPI 1154656254 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyExclusive Provider OrganizationManaged Care Organizations
Taxonomy Code302F00000X
License Licensed in CA · 040000336
Definition

(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.

4929 E KINGS CANYON RD, Fresno, CA 93727

Other Names 1

Doing Business AsKings Winery Medicla Clinic

Other Identifiers 1

MedicaidEAP70517FCA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D0715734

Kings Winery Medical Clinic · Fresno, CA
Active · expires Aug 31, 2026
CLIA Number05D0715734
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorApai Polyudhapoon
Laboratory Phone(209) 255-6476
Laboratory LocationKings Winery Medical Clinic4929 E Kings Canyon Rd, Fresno, CA 93727
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
4929 E KINGS CANYON RD
FRESNO, CA 93727
Psychiatry & Neurology (Psychiatry)
4929 E KINGS CANYON RD
FRESNO, CA 93727
Physician Assistant (Medical)
4929 E KINGS CANYON RD
FRESNO, CA 93727
Physician Assistant
4929 E KINGS CANYON RD
FRESNO, CA 93727
Social Worker (Clinical)
4929 E KINGS CANYON RD
FRESNO, CA 93727
Nurse Practitioner (Family)
4929 E KINGS CANYON RD
FRESNO, CA 93727
Nurse Practitioner
4929 E KINGS CANYON RD
FRESNO, CA 93727
Nurse Practitioner (Family)
4929 E KINGS CANYON RD
FRESNO, CA 93727

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1154656254, enumerated as an "organization" on October 07, 2009.

The provider is located at 4929 E KINGS CANYON RD FRESNO, CA 93727 and the phone number is (559) 255-6476.

Exclusive Provider Organization with taxonomy code 302F00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.