Provider Demographics
NPI:1508842873
Name:MONTEREY PENINSULA URGENT CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MONTEREY PENINSULA URGENT CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY-COHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-372-2273
Mailing Address - Street 1:245 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2409
Mailing Address - Country:US
Mailing Address - Phone:831-372-2273
Mailing Address - Fax:831-372-5840
Practice Address - Street 1:245 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2409
Practice Address - Country:US
Practice Address - Phone:831-372-2273
Practice Address - Fax:831-372-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00361660OtherBC/BS
CA00C433710OtherBC/BS
CAC36166OtherSTATE LICENSE
CA77047127OtherTAX ID
CA00C361660OtherCHAMPUS
CAG58815OtherSTATE LICENSE
CA00G588151OtherBC/BS
CAC43371OtherSTATE LICENSE
CA00C433710OtherBC/BS
CAA36182Medicare UPIN
CAE17545Medicare UPIN
CAF47919Medicare UPIN
CA00C361660OtherCHAMPUS
CA00C433710Medicare PIN
CA00C361660Medicare PIN