Provider Demographics
NPI:1689458416
Name:ARYA MEDICAL GROUP
Entity Type:Organization
Organization Name:ARYA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-424-0610
Mailing Address - Street 1:1660 E HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3346
Mailing Address - Country:US
Mailing Address - Phone:559-431-9753
Mailing Address - Fax:
Practice Address - Street 1:1348 W HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7181
Practice Address - Country:US
Practice Address - Phone:559-573-7260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARYA MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care