Provider Demographics
NPI:1275657827
Name:GOLDEN EMPIRE MANAGED CARE, A MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:GOLDEN EMPIRE MANAGED CARE, A MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RISTENPART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-716-7100
Mailing Address - Street 1:4550 CALIFORNIA AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7012
Mailing Address - Country:US
Mailing Address - Phone:661-716-7100
Mailing Address - Fax:661-716-9211
Practice Address - Street 1:4550 CALIFORNIA AVE
Practice Address - Street 2:STE 500
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7012
Practice Address - Country:US
Practice Address - Phone:661-716-7100
Practice Address - Fax:661-716-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2807675302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization