Provider Demographics
NPI:1366032047
Name:FLORENCE MEDICAL GROUP OF CALIFORNIA PC
Entity Type:Organization
Organization Name:FLORENCE MEDICAL GROUP OF CALIFORNIA PC
Other - Org Name:FLORENCE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-738-6356
Mailing Address - Street 1:281 LA COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-8774
Mailing Address - Country:US
Mailing Address - Phone:202-893-7910
Mailing Address - Fax:202-893-8809
Practice Address - Street 1:1046 MANGROVE AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3548
Practice Address - Country:US
Practice Address - Phone:530-332-8877
Practice Address - Fax:530-332-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty