Provider Demographics
NPI:1245403278
Name:SURGICAL GROUP OF MERCED
Entity Type:Organization
Organization Name:SURGICAL GROUP OF MERCED
Other - Org Name:HANSON DICARLO AND MEDEFIND MDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-722-8122
Mailing Address - Street 1:411 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3713
Mailing Address - Country:US
Mailing Address - Phone:209-722-8122
Mailing Address - Fax:209-722-9849
Practice Address - Street 1:411 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3713
Practice Address - Country:US
Practice Address - Phone:209-722-8122
Practice Address - Fax:209-722-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38130208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ281742ZMedicare PIN