Provider Demographics
NPI:1124216684
Name:PIERRE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PIERRE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-496-9190
Mailing Address - Street 1:77 ROLLING OAKS DR STE 207
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1019
Mailing Address - Country:US
Mailing Address - Phone:805-496-9190
Mailing Address - Fax:805-496-9185
Practice Address - Street 1:77 ROLLING OAKS DR STE 207
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1019
Practice Address - Country:US
Practice Address - Phone:805-496-9190
Practice Address - Fax:805-496-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH30926Medicare UPIN