Provider Demographics
NPI:1225065170
Name:ANDREW C. KERR, M.D. INC
Entity Type:Organization
Organization Name:ANDREW C. KERR, M.D. INC
Other - Org Name:LOMA VISTA FAMILY PRACTICE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-648-3316
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-0996
Mailing Address - Country:US
Mailing Address - Phone:805-648-3316
Mailing Address - Fax:805-641-2881
Practice Address - Street 1:3555 LOMA VISTA RD STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-648-3316
Practice Address - Fax:805-641-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16417Medicare ID - Type UnspecifiedMEDICARE ID#