1. Home
  2. Directory
  3. California
  4. Jamestown
  5. Clinic Center
  6. NPI Profile

MATHIESEN MEMORIAL HEALTH CLINIC
NPI 1255595484
Clinic/Center - Federally Qualified Health Center (FQHC) in Jamestown, CA

Active since July 16, 2008CLIA 05D1088264 · Waiver
18144 SECO ST, JAMESTOWN, CA 95327(209) 984-4820(209) 984-4825 Get Directions Write a Review

NPPES record last updated: July 25, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mathiesen Memorial Health Clinic NPPES

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

MATHIESEN MEMORIAL HEALTH CLINIC (NPI 1255595484) is a healthcare organization registered as a federally qualified health center (fqhc) in Jamestown, California and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through August 19, 2026, maintains 3 additional practice locations, and lists Jacqueline Kiss, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1255595484
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameMATHIESEN MEMORIAL HEALTH CLINIC
Location Address18144 SECO STJamestown, CA 95327-9737
Mailing AddressPo Box 535Jamestown, CA 95327-0535 · (209) 984-4820 · Fax (209) 984-4825
Phone(209) 984-4820
Fax(209) 984-4825
Organization SubpartNo
Authorized OfficialJacqueline KissCredentialing · (254) 760-0228
Enumeration DateJuly 16, 2008
Last NPPES UpdateJuly 25, 2023
NPPES CertifiedJuly 24, 2023
✔ NPI 1255595484 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
18144 SECO ST, Jamestown, CA 95327
Open in Google Maps ↗

Secondary Practice Locations 3

Location 118232 Smoke StJamestown, CA 95327-9218 · Phone (209) 984-4820
Location 218158 Main StJamestown, CA 95327-9254 · Phone (209) 984-4820
Location 318268 Main StJamestown, CA 95327-9256 · Phone (209) 984-4820

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 of Waiver 05D1088264

Mathiesen Memorial Health Clinic · Jamestown, CA
Active · expires Aug 19, 2026
CLIA Number05D1088264
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateAugust 20, 2024
Certificate Expiration DateAugust 19, 2026
Laboratory DirectorSteven E. Sheild
Laboratory Phone(209) 984-4820
Laboratory LocationMathiesen Memorial Health Clinic18144 Seco St, Jamestown, CA 95327
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 16

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

CHANTELL WEIR FNP
Nurse Practitioner (Family)
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820
DR. HAKU KEVIN KAHOANO M.D.
General Practice
18144 SECO ST, MATHIESEN MEMORIAL HEALTH CLINIC
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4824
COURTNEY WISEMAN PA
Physician Assistant
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820
MS. DAYNA DECRISTOFERI LMFT
Marriage & Family Therapist
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820
GINA M VALENTE-MOORE FNP
Nurse Practitioner (Family)
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820
MATHIESEN MEMORIAL HEALTH CENTER
Clinic/Center (Primary Care)
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820
HANNAH GARRETT RDH
Dental Hygienist
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820
THERESA LYNN SALES FNP
Nurse Practitioner
18144 SECO ST
JAMESTOWN, CA 95327
Tuolumne County (209) 984-4820

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mathiesen Memorial Health Clinic's NPI number?

The NPI number for Mathiesen Memorial Health Clinic is 1255595484. It was assigned to this organization in the NPPES registry on July 16, 2008.

Where is Mathiesen Memorial Health Clinic located?

Mathiesen Memorial Health Clinic is located at 18144 Seco St, Jamestown, CA 95327. The listed phone number is (209) 984-4820.

What is Mathiesen Memorial Health Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Mathiesen Memorial Health Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1088264) is associated with this NPI, valid through August 19, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mathiesen Memorial Health Clinic was last updated on July 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.