Provider Demographics
NPI:1609112499
Name:GETTYSBURG MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:GETTYSBURG MEDICAL CLINIC INC
Other - Org Name:GETTYSBURG MEDICAL CLINIC,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:WEE
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-244-6360
Mailing Address - Street 1:5088 N FRESNO ST STE D
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7611
Mailing Address - Country:US
Mailing Address - Phone:559-222-9362
Mailing Address - Fax:559-222-9369
Practice Address - Street 1:5088 N FRESNO ST STE D
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7611
Practice Address - Country:US
Practice Address - Phone:559-222-9362
Practice Address - Fax:559-222-9369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GETTYSBURG MEDICAL CLINIC,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty