Provider Demographics
NPI:1154318426
Name:RAPIDCARE WALK IN MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RAPIDCARE WALK IN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVITIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-676-8234
Mailing Address - Street 1:4062 FLYING C RD STE 41
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9664
Mailing Address - Country:US
Mailing Address - Phone:530-676-8234
Mailing Address - Fax:530-676-0819
Practice Address - Street 1:4062 FLYING C RD
Practice Address - Street 2:#41
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9664
Practice Address - Country:US
Practice Address - Phone:530-676-8234
Practice Address - Fax:530-676-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ28279Z261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064420Medicaid
CA0878140001Medicare NSC
CAZZZ28279ZMedicare ID - Type Unspecified