1659472041 NPI number — OB GYN ASSOCIATES OF TURLOCK A MEDICAL GROUP INC

Table of content: (NPI 1659472041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659472041 NPI number — OB GYN ASSOCIATES OF TURLOCK A MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OB GYN ASSOCIATES OF TURLOCK A 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:
1659472041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1729 N OLIVE AVE
Provider Second Line Business Mailing Address:
3
Provider Business Mailing Address City Name:
TURLOCK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95382-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-634-9034
Provider Business Mailing Address Fax Number:
209-634-0794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1729 N OLIVE AVE
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95382-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-634-9034
Provider Business Practice Location Address Fax Number:
209-634-0794
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCAULEY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-634-9034

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G65192 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: A32115 , 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: GR0043050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".