Provider Demographics
NPI:1689759565
Name:FAMILY CARE PROVIDERS MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:FAMILY CARE PROVIDERS MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-495-6758
Mailing Address - Street 1:1300 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3845
Mailing Address - Country:US
Mailing Address - Phone:559-495-6702
Mailing Address - Fax:559-495-6781
Practice Address - Street 1:1300 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3845
Practice Address - Country:US
Practice Address - Phone:559-495-6702
Practice Address - Fax:559-495-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX59230Medicaid