Provider Demographics
NPI:1083644801
Name:FRESNO CHILDREN'S MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:FRESNO CHILDREN'S MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-438-2300
Mailing Address - Street 1:7720 N FRESNO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2407
Mailing Address - Country:US
Mailing Address - Phone:559-438-2300
Mailing Address - Fax:559-438-1531
Practice Address - Street 1:7720 N FRESNO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2407
Practice Address - Country:US
Practice Address - Phone:559-438-2300
Practice Address - Fax:559-438-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty