Provider Demographics
NPI:1053641753
Name:H. JAMES PRINCETON, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:H. JAMES PRINCETON, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:PREMIER WALK-IN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PRINCETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-625-6080
Mailing Address - Street 1:5344 W CYPRESS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8339
Mailing Address - Country:US
Mailing Address - Phone:559-625-6080
Mailing Address - Fax:559-625-6024
Practice Address - Street 1:4025 W CALDWELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9224
Practice Address - Country:US
Practice Address - Phone:559-733-4505
Practice Address - Fax:559-733-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ01495ZMedicare PIN