Provider Demographics
NPI:1437347721
Name:THE FRESNO CENTER
Entity Type:Organization
Organization Name:THE FRESNO CENTER
Other - Org Name:CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-255-8395
Mailing Address - Street 1:4879 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3811
Mailing Address - Country:US
Mailing Address - Phone:559-255-8395
Mailing Address - Fax:559-255-1656
Practice Address - Street 1:4855 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3811
Practice Address - Country:US
Practice Address - Phone:559-255-8395
Practice Address - Fax:559-255-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports BrokerageGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000001009Medicaid