Provider Demographics
NPI:1497374904
Name:OLLIE HEALTH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:OLLIE HEALTH MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-546-9535
Mailing Address - Street 1:9700 BUSINESS PARK DR STE 406
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1718
Mailing Address - Country:US
Mailing Address - Phone:916-546-9535
Mailing Address - Fax:
Practice Address - Street 1:9700 BUSINESS PARK DR STE 406
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1718
Practice Address - Country:US
Practice Address - Phone:916-546-9535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty