Provider Demographics
NPI:1083894901
Name:SALINAS VALLEY ORTHOPEDICS & SPORTS MED A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SALINAS VALLEY ORTHOPEDICS & SPORTS MED A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-424-0313
Mailing Address - Street 1:321 E ROMIE LANE
Mailing Address - Street 2:STE A
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3168
Mailing Address - Country:US
Mailing Address - Phone:831-424-0313
Mailing Address - Fax:831-424-2192
Practice Address - Street 1:321 E ROMIE LANE
Practice Address - Street 2:STE A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3168
Practice Address - Country:US
Practice Address - Phone:831-424-0313
Practice Address - Fax:831-424-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25474207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002190Medicaid
CAA89419Medicare UPIN
CAZZZ85039ZMedicare PIN