Provider Demographics
NPI:1073944393
Name:DOCTORS MEDICAL CENTER OF MODESTO
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER OF MODESTO
Other - Org Name:EMANUEL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CMO; TENET
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-428-6812
Mailing Address - Street 1:PO BOX 743399
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3399
Mailing Address - Country:US
Mailing Address - Phone:209-573-6102
Mailing Address - Fax:
Practice Address - Street 1:1010 W LAS PALMAS AVE
Practice Address - Street 2:STE E
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8873
Practice Address - Country:US
Practice Address - Phone:209-895-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty