Provider Demographics
NPI:1538285697
Name:TEHACHAPI MEDICAL CLINIC
Entity Type:Organization
Organization Name:TEHACHAPI MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PESCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:661-822-2530
Mailing Address - Street 1:PO BOX 2525
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-2525
Mailing Address - Country:US
Mailing Address - Phone:661-822-2530
Mailing Address - Fax:661-822-2536
Practice Address - Street 1:1001 W TEHACHAPI BLVD
Practice Address - Street 2:SUITE A-100
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2532
Practice Address - Country:US
Practice Address - Phone:661-822-2530
Practice Address - Fax:661-822-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD16143Medicare UPIN
020A57320Medicare ID - Type Unspecified