Provider Demographics
NPI:1356660302
Name:B&G PA MEDICAL SERVICES
Entity Type:Organization
Organization Name:B&G PA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:DUNAYE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:916-801-6988
Mailing Address - Street 1:4027 BANCROFT DR.
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-933-4050
Mailing Address - Fax:
Practice Address - Street 1:4027 BANCROFT DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-6935
Practice Address - Country:US
Practice Address - Phone:916-933-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS02410Medicare UPIN