Provider Demographics
NPI:1619968583
Name:HIGHGROVE MEDICAL CLINIC,INC
Entity Type:Organization
Organization Name:HIGHGROVE MEDICAL CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FREESEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-326-1600
Mailing Address - Street 1:2701 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2016
Mailing Address - Country:US
Mailing Address - Phone:661-326-1600
Mailing Address - Fax:661-323-0889
Practice Address - Street 1:2701 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2016
Practice Address - Country:US
Practice Address - Phone:661-326-1600
Practice Address - Fax:661-323-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42525174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02964Medicare UPIN
CAP51129Medicare UPIN
CAH47339Medicare UPIN
CAA42347Medicare UPIN
ARH63763Medicare UPIN
CAH62850Medicare UPIN
CAP42922Medicare UPIN
CAF00921Medicare UPIN
CAP57272Medicare UPIN
CAE24983Medicare UPIN
CAG33571Medicare UPIN
CAS51215Medicare UPIN
CAZZZ01707ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER