Provider Demographics
NPI:1467437376
Name:COMMUNITY HOSPITALIST MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALIST MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:559-228-5400
Mailing Address - Street 1:PO BOX 28901
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8901
Mailing Address - Country:US
Mailing Address - Phone:559-228-4222
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:1180 E SHAW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7812
Practice Address - Country:US
Practice Address - Phone:559-228-4222
Practice Address - Fax:559-228-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089710Medicaid
CAGR0089710Medicaid
CAZZZ21073ZMedicare ID - Type Unspecified