Provider Demographics
NPI:1346646072
Name:ORTHOGEN, INC.
Entity Type:Organization
Organization Name:ORTHOGEN, INC.
Other - Org Name:SYNERGY HEALTH CENTER & URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:925-350-4742
Mailing Address - Street 1:3128 SANTA RITA RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8300
Mailing Address - Country:US
Mailing Address - Phone:925-350-4742
Mailing Address - Fax:800-507-0879
Practice Address - Street 1:3128 SANTA RITA RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8300
Practice Address - Country:US
Practice Address - Phone:925-350-4742
Practice Address - Fax:800-507-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551003261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP72583Medicare UPIN