Provider Demographics
NPI:1710236906
Name:VVS PRIMARY CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:VVS PRIMARY CARE MEDICAL GROUP, INC.
Other - Org Name:PIEDMONT PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-428-4900
Mailing Address - Street 1:1345 GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1000
Mailing Address - Country:US
Mailing Address - Phone:510-428-4900
Mailing Address - Fax:510-428-4904
Practice Address - Street 1:1345 GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1000
Practice Address - Country:US
Practice Address - Phone:510-428-4900
Practice Address - Fax:510-428-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-03
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty