Provider Demographics
NPI: | 1811027188 |
---|---|
Name: | PHYSICIANS MEDICAL GROUP OF SANTA CRUZ, INC |
Entity Type: | Organization |
Organization Name: | PHYSICIANS MEDICAL GROUP OF SANTA CRUZ, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CINDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | COO |
Authorized Official - Phone: | 831-465-7829 |
Mailing Address - Street 1: | 100 ENTERPRISE WAY STE C110 |
Mailing Address - Street 2: | |
Mailing Address - City: | SCOTTS VALLEY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95066-3242 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 831-465-7800 |
Mailing Address - Fax: | 831-464-7044 |
Practice Address - Street 1: | 100 ENTERPRISE WAY STE C110 |
Practice Address - Street 2: | |
Practice Address - City: | SCOTTS VALLEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95066-3242 |
Practice Address - Country: | US |
Practice Address - Phone: | 831-465-7800 |
Practice Address - Fax: | 831-464-7044 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-06 |
Last Update Date: | 2016-02-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302R00000X | Managed Care Organizations | Health Maintenance Organization |