Provider Demographics
NPI:1083728877
Name:THE SPALDING GROUP INC
Entity Type:Organization
Organization Name:THE SPALDING GROUP INC
Other - Org Name:MEDICAL DYNAMICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-573-0302
Mailing Address - Street 1:750 MENDOCINO AVE
Mailing Address - Street 2:#9
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401
Mailing Address - Country:US
Mailing Address - Phone:707-573-0302
Mailing Address - Fax:707-573-0484
Practice Address - Street 1:750 MENDOCINO AVE
Practice Address - Street 2:#9
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-573-0302
Practice Address - Fax:707-573-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100041332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01641FOtherMEDI CAL
CADME01641FOtherMEDI CAL