1932380383 NPI number — MERIDIAN MEDICAL GROUP, P.C.

Table of content: (NPI 1932380383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932380383 NPI number — MERIDIAN MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN MEDICAL GROUP, P.C.
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:
1932380383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95156-3278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-624-5288
Provider Business Mailing Address Fax Number:
209-624-5289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 NORTHGATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95336-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-624-5288
Provider Business Practice Location Address Fax Number:
209-624-5289
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-624-5288

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , 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: GR0070180 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0070181 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ41448Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1457439572 . This is a "NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972602464 . This is a "NPI NUMBERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1730273855 . This is a "NPI NUMBERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0070182 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134228752 . This is a "NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720171598 . This is a "NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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