1417456542 NPI number — KERN RADIOLOGY MEDICAL GROUP, INC

Table of content: (NPI 1417456542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417456542 NPI number — KERN RADIOLOGY MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERN RADIOLOGY 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:
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NPI Number Information

NPI Number:
1417456542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 MORNING DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93306-7277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-326-9600
Provider Business Mailing Address Fax Number:
661-334-3065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MUNZER ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAFTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93263-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-326-9600
Provider Business Practice Location Address Fax Number:
661-334-3065
Provider Enumeration Date:
02/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
STURZ
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
LYLE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
661-326-9600

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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)





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