Provider Demographics
NPI:1235238841
Name:THE DOCTORS CENTER MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:THE DOCTORS CENTER MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-966-6287
Mailing Address - Street 1:4948 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4606
Mailing Address - Country:US
Mailing Address - Phone:916-966-6287
Mailing Address - Fax:916-966-2541
Practice Address - Street 1:4948 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4606
Practice Address - Country:US
Practice Address - Phone:916-966-6287
Practice Address - Fax:916-966-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13047ZOtherBLUE SHIELD
CACP5265Medicare PIN
CAZZZ13047ZOtherBLUE SHIELD
CAZZZ13047ZMedicare PIN