Provider Demographics
NPI:1568473478
Name:SARATOGA MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:SARATOGA MEDICAL CLINIC INC
Other - Org Name:SARATOGA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-243-6911
Mailing Address - Street 1:1060 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3402
Mailing Address - Country:US
Mailing Address - Phone:408-243-6911
Mailing Address - Fax:408-243-6941
Practice Address - Street 1:1060 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3402
Practice Address - Country:US
Practice Address - Phone:408-243-6911
Practice Address - Fax:408-243-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42512261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC42512OtherPHYSICIAN AND SURGEON CERTIFICATE
CAPTAN DF676AOtherMEDICARE GROUP PTAN
CAC42512OtherPHYSICIAN AND SURGEON CERTIFICATE