Provider Demographics
NPI:1750319794
Name:KERN RADIOLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:KERN RADIOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STURZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-326-9600
Mailing Address - Street 1:2301 BAHAMAS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0663
Mailing Address - Country:US
Mailing Address - Phone:661-326-9600
Mailing Address - Fax:661-334-3065
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1888
Practice Address - Country:US
Practice Address - Phone:661-322-9958
Practice Address - Fax:661-325-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0047422Medicaid
CAGR0047422Medicaid