Provider Demographics
NPI:1619908365
Name:MUIR OBSTETRICS & GYNECOLOGIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MUIR OBSTETRICS & GYNECOLOGIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:925-933-4747
Mailing Address - Street 1:112 LA CASA VIA STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3011
Mailing Address - Country:US
Mailing Address - Phone:925-933-4747
Mailing Address - Fax:925-933-1638
Practice Address - Street 1:112 LA CASA VIA STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3011
Practice Address - Country:US
Practice Address - Phone:925-933-4747
Practice Address - Fax:925-933-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40358Medicare UPIN
CAF68729Medicare UPIN
CAA58967Medicare UPIN
CAA56305Medicare UPIN
CAH41518Medicare UPIN
CAE78685Medicare UPIN