Provider Demographics
NPI:1326013657
Name:SIGMUND PHYSICIAN SERVICE, INC.
Entity Type:Organization
Organization Name:SIGMUND PHYSICIAN SERVICE, INC.
Other - Org Name:MEE AT PASO URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIGMUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-239-1555
Mailing Address - Street 1:3000 BROAD ST
Mailing Address - Street 2:SUITE 209A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6786
Mailing Address - Country:US
Mailing Address - Phone:805-547-1255
Mailing Address - Fax:805-547-1395
Practice Address - Street 1:416 SPRING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3161
Practice Address - Country:US
Practice Address - Phone:805-239-1555
Practice Address - Fax:805-239-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2818999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2818999OtherSTATE LICENSE
7858764OtherAETNA
CAZZZ66646ZOtherBLUE SHIELD OF CA
0217526OtherWASHINGTON STATE DOL
5681622OtherCCN / FIRST HEALTH
CAZZZ66646ZOtherBLUE SHIELD OF CA