Provider Demographics
NPI:1083729727
Name:AMADOR VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:AMADOR VALLEY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KEMPRUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-828-9211
Mailing Address - Street 1:7667 AMADOR VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2341
Mailing Address - Country:US
Mailing Address - Phone:925-828-9211
Mailing Address - Fax:925-828-0847
Practice Address - Street 1:7667 AMADOR VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2341
Practice Address - Country:US
Practice Address - Phone:925-828-9211
Practice Address - Fax:925-828-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28372261QP2300X, 261QX0100X
CAG283372261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15212-1OtherFEDERAL AVIATION ADMIN.
CAG28372OtherLICENSE
CAG28372OtherLICENSE
CAA36898Medicare UPIN