1083725220 NPI number — NEUROSURGICAL ASSOCIATES MEDICAL GROUP INC

Table of content: DR. PATRICK T. PAN MD (NPI 1922057587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083725220 NPI number — NEUROSURGICAL ASSOCIATES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL ASSOCIATES MEDICAL GROUP INC
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:
Provider Other Organization Name Type Code:
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:
1083725220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7130 N SHARON AVE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-3386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-449-1100
Provider Business Mailing Address Fax Number:
559-449-1174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7130 N SHARON AVE
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-449-1100
Provider Business Practice Location Address Fax Number:
559-449-1174
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANT
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
JASON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-449-1100

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 195946200 . This is a "USDL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CS6929 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR008950 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5367510001 . This is a "MEDICARE DMEPOS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com