1326013657 NPI number — SIGMUND PHYSICIAN SERVICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326013657 NPI number — SIGMUND PHYSICIAN SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGMUND PHYSICIAN SERVICE, 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:
6
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:
1326013657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 BROAD ST
Provider Second Line Business Mailing Address:
SUITE 209A
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-6786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-547-1255
Provider Business Mailing Address Fax Number:
805-547-1395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 SPRING ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PASO ROBLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93446-3161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-239-1555
Provider Business Practice Location Address Fax Number:
805-239-1444
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIGMUND
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-239-1555

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2818999 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2818999 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7858764 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ66646Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0217526 . This is a "WASHINGTON STATE DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5681622 . This is a "CCN / FIRST HEALTH" identifier . This identifiers is of the category "OTHER".




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