Provider Demographics
NPI:1639100118
Name:NORTH FRESNO EMERGENCY PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTH FRESNO EMERGENCY PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-450-3263
Mailing Address - Street 1:PO BOX 28951
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8951
Mailing Address - Country:US
Mailing Address - Phone:888-398-1370
Mailing Address - Fax:
Practice Address - Street 1:1303 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3309
Practice Address - Country:US
Practice Address - Phone:559-450-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ34627ZOtherBLUE SHIELD
183701800OtherUS DEPT OF LABOR/WC
CAGR0053910Medicaid
204042OtherUS DEPT OF LABOR/ENERGY
ZZZ34627ZOtherBLUE SHIELD
CAGR0053910Medicaid
204042OtherUS DEPT OF LABOR/ENERGY