Provider Demographics
NPI:1285670406
Name:MMC EMERGENCY PHYSICIANS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MMC EMERGENCY PHYSICIANS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:COTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-748-4502
Mailing Address - Street 1:PO BOX 94913
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-4913
Mailing Address - Country:US
Mailing Address - Phone:800-962-3303
Mailing Address - Fax:805-739-3064
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-739-3200
Practice Address - Fax:805-739-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207P00000X
207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0054630Medicaid
CAHW11906Medicare PIN