Provider Demographics
NPI:1497849574
Name:VALLEY EMERGENCY PHYSICIANS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:VALLEY EMERGENCY PHYSICIANS MEDICAL GROUP, INC
Other - Org Name:MERCY MT. SHASTA MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-634-8405
Mailing Address - Street 1:P.O. BOX 12259
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-2259
Mailing Address - Country:US
Mailing Address - Phone:888-634-8405
Mailing Address - Fax:
Practice Address - Street 1:914 PINE STREET
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2143
Practice Address - Country:US
Practice Address - Phone:530-926-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64122207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094390Medicaid
CAZZZ27885ZMedicare PIN