Provider Demographics
NPI:1821075748
Name:COMMUNITY MEDICAL PROVIDERS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL PROVIDERS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-228-5400
Mailing Address - Street 1:PO BOX 28900
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:1180 E SHAW AVE
Practice Address - Street 2:STE 125
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7812
Practice Address - Country:US
Practice Address - Phone:559-228-4200
Practice Address - Fax:559-224-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068691Medicaid
CAGR0068696Medicaid
CAGR0068690Medicaid
CAGR0068695Medicaid
CAGR0068692Medicaid
CAGR0068693Medicaid
CAGR0068694Medicaid
CAGR0068695Medicaid
CABR459ZMedicare PIN
CACE2327Medicare PIN
CAGR0068690Medicaid
CAZZZ14493ZMedicare PIN
CAZZZ31935ZMedicare PIN
CAZZZ14495ZMedicare PIN
CAGR0068691Medicaid
CAZZZ14496ZMedicare PIN
CAZZZ14469ZMedicare PIN
CAZZZ14467ZMedicare PIN
CAZZZ14466ZMedicare PIN