Provider Demographics
NPI:1629721196
Name:PHYSICIANS MEDICAL HOLDINGS
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-937-3601
Mailing Address - Street 1:2304 ZANKER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1115
Mailing Address - Country:US
Mailing Address - Phone:408-937-3600
Mailing Address - Fax:408-347-8077
Practice Address - Street 1:2304 ZANKER ROAD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1115
Practice Address - Country:US
Practice Address - Phone:408-937-3600
Practice Address - Fax:408-347-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty