1982667473 NPI number — FRANK M DE MAYO M D P C

Table of content: (NPI 1982667473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982667473 NPI number — FRANK M DE MAYO M D P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK M DE MAYO M D 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:
TRACY ORTHOPEDICS AND SPORTS MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1982667473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
793 S TRACY BLVD STE 332
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95376-4753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-835-8888
Provider Business Mailing Address Fax Number:
209-835-6424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 W EATON AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95376-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-835-4888
Provider Business Practice Location Address Fax Number:
209-835-6424
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DE MAYO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT/SURGEON
Authorized Official Telephone Number:
209-835-4888

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  A38277 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: G60003 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: G60003 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 26664 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 26664 . This is a "ANTHONY PHILLIPS - PT LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5673742 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 90686 . This is a "INTERPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0087960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 032034 . This is a "HILL PHYSICIANS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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