Provider Demographics
NPI:1407129349
Name:GETTYSBURG MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:GETTYSBURG MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:WEE
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-244-6360
Mailing Address - Street 1:3121 E. OLIVE AVE.
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-1032
Mailing Address - Country:US
Mailing Address - Phone:559-244-6362
Mailing Address - Fax:559-434-8429
Practice Address - Street 1:301 E HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0887
Practice Address - Country:US
Practice Address - Phone:559-244-6362
Practice Address - Fax:559-434-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34863208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty