Provider Demographics
NPI:1639281413
Name:PRIMARY CARE CONSULTANTS, INC. A MEDICAL GROUP
Entity Type:Organization
Organization Name:PRIMARY CARE CONSULTANTS, INC. A MEDICAL GROUP
Other - Org Name:RANCHOS FAMILY HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-297-1322
Mailing Address - Street 1:255 W BULLARD AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0861
Mailing Address - Country:US
Mailing Address - Phone:559-297-1322
Mailing Address - Fax:559-322-9161
Practice Address - Street 1:11976 ROAD 37
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8612
Practice Address - Country:US
Practice Address - Phone:559-645-4194
Practice Address - Fax:559-645-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53943FMedicaid
CARHM53943FMedicaid
CAZZZ21676ZMedicare PIN