Provider Demographics
NPI:1538123658
Name:MONTEREY PENINSULA ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:MONTEREY PENINSULA ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE
Other - Org Name:URGENCYMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-643-9788
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942
Mailing Address - Country:US
Mailing Address - Phone:831-643-9788
Mailing Address - Fax:831-657-0161
Practice Address - Street 1:10 HARRIS CT
Practice Address - Street 2:BLDG A SUITE A-1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-643-9788
Practice Address - Fax:831-657-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31145111N00000X
CA20A6704207Q00000X
CAG16156207Q00000X
CA41685207RE0101X
CAG69478207X00000X
CAG43197207X00000X
CAC31358207X00000X
CA20A6688208100000X
CANP95001838363LF0000X
CANP23732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06135ZOtherBLUE SHIELD
CAZZZ21511ZMedicare PIN