NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Provider Demographics

• NPI: 1467444711
• Name: NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC
• Entity Type: Organization
• Organization Name: NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: WILLIAM
• Authorized Official - Middle Name: R
• Authorized Official - Last Name: VETTER
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 916-733-1788
• Mailing Address - Street 1: 1330 21ST STREET #201
• Mailing Address - Street 2: C/O MIDTOWN FINANCIAL
• Mailing Address - City: SACRAMENTO
• Mailing Address - State: CA
• Mailing Address - Zip Code: 95811-4231
• Mailing Address - Country: US
• Mailing Address - Phone: 916-561-6848
• Mailing Address - Fax: 916-447-9210
• Practice Address - Street 1: 5301 F ST
• Practice Address - Street 2: #117
• Practice Address - City: SACRAMENTO
• Practice Address - State: CA
• Practice Address - Zip Code: 95819-3226
• Practice Address - Country: US
• Practice Address - Phone: 916-733-1788
• Practice Address - Fax: 916-733-1787
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-08-22
• Last Update Date: 2009-10-20

Provider Licenses

State	License ID	Taxonomies
CA	207RC0000X	207RC0000X
CA	207RC0001X	207RC0001X
CA	207R10011X	207RI0011X
CA	207UN0901X	207UN0901X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Single Specialty
No	207RC0001X	Allopathic & Osteopathic Physicians	Internal Medicine	Clinical Cardiac Electrophysiology	Group - Single Specialty
No	207RI0011X	Allopathic & Osteopathic Physicians	Internal Medicine	Interventional Cardiology	Group - Single Specialty
No	207UN0901X	Allopathic & Osteopathic Physicians	Nuclear Medicine	Nuclear Cardiology	Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	GR0063163	Medicaid
CA	ZZZ075232	Other	BLUE SHIELD OF CA
CA	DA7085	Other	RAILROAD MEDICARE PIN
CA	GR0063161	Medicaid
CA	ZZZ07524Z	Other	BLUE SHIELD OF CA
CA	ZZZ07522Z	Other	BLUE SHIELD OF CA
CA	GR0063162	Medicaid
CA	GR0063160	Medicaid
CA	GR0063164	Medicaid
CA	ZZZ08053Z	Other	BLUE SHIELD OF CA
CA	ZZZ66346Z	Other	BLUE SHIELD OF CA
CA	DB9095	Other	RAILROAD MEDICARE PIN
CA	ZZZ27385Z	Medicare PIN
CA	ZZZ03498Z	Medicare PIN
CA	GR0063160	Medicaid
CA	ZZZ07522Z	Other	BLUE SHIELD OF CA
CA	ZZZ27317Z	Medicare PIN