1891840088 NPI number — CENTRAL COAST URGENT CARE MEDICAL GROUP

Table of content: (NPI 1891840088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891840088 NPI number — CENTRAL COAST URGENT CARE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL COAST URGENT CARE MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL COAST URGENT CARE CENTER
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891840088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-8722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-922-0561
Provider Business Mailing Address Fax Number:
805-922-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 EAST BETTERAVIA RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-7847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-922-0561
Provider Business Practice Location Address Fax Number:
805-922-0083
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARUSO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN PARTNER
Authorized Official Telephone Number:
805-922-0561

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: WG48284A . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WA50123B . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WPT10965B . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245327840 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WG61780E . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WPT8518A . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1083643878 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1376510529 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W8259 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1609965433 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ16208Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1437246022 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1891840088 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WG32607A . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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