Provider Demographics
NPI:1508302977
Name:STAT MED PC A CALIFORNIA MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STAT MED PC A CALIFORNIA MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:STAT MED URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-234-4447
Mailing Address - Street 1:901 SUNVALLEY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5816
Mailing Address - Country:US
Mailing Address - Phone:925-234-4447
Mailing Address - Fax:
Practice Address - Street 1:901 SUNVALLEY BLVD
Practice Address - Street 2:100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5899
Practice Address - Country:US
Practice Address - Phone:925-234-4447
Practice Address - Fax:925-234-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA110396Medicare PIN