Provider Demographics
NPI:1245575752
Name:VVS PRIMARY CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:VVS PRIMARY CARE MEDICAL GROUP
Other - Org Name:PIEDMONT PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-594-7400
Mailing Address - Street 1:2299 BACON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2050
Mailing Address - Country:US
Mailing Address - Phone:925-691-1900
Mailing Address - Fax:925-691-1909
Practice Address - Street 1:2299 BACON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2050
Practice Address - Country:US
Practice Address - Phone:925-691-1900
Practice Address - Fax:925-691-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty