Provider Demographics
NPI:1003995101
Name:EMG
Entity Type:Organization
Organization Name:EMG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-444-7454
Mailing Address - Street 1:10225 AUSTIN DR
Mailing Address - Street 2:STE #103
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1500
Mailing Address - Country:US
Mailing Address - Phone:619-660-6719
Mailing Address - Fax:619-660-5934
Practice Address - Street 1:10225 AUSTIN DR
Practice Address - Street 2:STE #103
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1500
Practice Address - Country:US
Practice Address - Phone:619-660-6719
Practice Address - Fax:619-660-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W11716OtherMEDICARE CROUP #