Provider Demographics
NPI:1497895361
Name:MADHU K. KRIS M.D.
Entity Type:Organization
Organization Name:MADHU K. KRIS M.D.
Other - Org Name:MERCED AMBULATORY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:K
Authorized Official - Last Name:KRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-384-3116
Mailing Address - Street 1:750 W OLIVE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2436
Mailing Address - Country:US
Mailing Address - Phone:209-384-3116
Mailing Address - Fax:
Practice Address - Street 1:750 W OLIVE AVE
Practice Address - Street 2:SUITE 107A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2436
Practice Address - Country:US
Practice Address - Phone:209-384-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00367MMedicare ID - Type UnspecifiedPROVIDER NUMBER