Provider Demographics
NPI:1689191611
Name:GEM PHYSICIANS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:GEM PHYSICIANS MEDICAL GROUP INC
Other - Org Name:GMA HEALTHCARE PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-665-0505
Mailing Address - Street 1:4550 CALIFORNIA AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7012
Mailing Address - Country:US
Mailing Address - Phone:661-716-7100
Mailing Address - Fax:661-716-5484
Practice Address - Street 1:3737 SAN DIMAS ST STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5733
Practice Address - Country:US
Practice Address - Phone:661-716-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEM PHYSICIANS MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty