Provider Demographics
NPI:1497924260
Name:MIDDLE PATH MEDICINE
Entity Type:Organization
Organization Name:MIDDLE PATH MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:FORESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-481-3442
Mailing Address - Street 1:180 W LE POINT ST
Mailing Address - Street 2:#A
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-481-3442
Mailing Address - Fax:805-481-3443
Practice Address - Street 1:180 W LE POINT ST
Practice Address - Street 2:#A
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-481-3442
Practice Address - Fax:805-481-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66487261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care