Provider Demographics
NPI:1326060153
Name:CENTRAL CAL ORTHOPEDIC MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CENTRAL CAL ORTHOPEDIC MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-215-3523
Mailing Address - Street 1:1801 COLORADO AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2710
Mailing Address - Country:US
Mailing Address - Phone:209-216-3500
Mailing Address - Fax:209-215-3505
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:STE 250
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2710
Practice Address - Country:US
Practice Address - Phone:209-216-3500
Practice Address - Fax:209-215-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA352208600OtherACS/U.S. DEPT. OF LABOR
CADE2153OtherRAILROAD MEDICARE
CA4647970001OtherMEDICARE/CIGNA DME
CAZZZ05764ZOtherBLUE SHIELD
CAZZZ05764ZOtherBLUE SHIELD