Provider Demographics
NPI:1700821477
Name:MERCED MRI MEDICAL GROUP
Entity Type:Organization
Organization Name:MERCED MRI MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-938-9685
Mailing Address - Street 1:3365 G ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0964
Mailing Address - Country:US
Mailing Address - Phone:209-384-2121
Mailing Address - Fax:209-384-4269
Practice Address - Street 1:3365 G ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0964
Practice Address - Country:US
Practice Address - Phone:209-384-2121
Practice Address - Fax:209-384-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085U0001X
261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0041350Medicaid
CAGR0041350Medicaid