Provider Demographics
NPI:1821205469
Name:MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Entity Type:Organization
Organization Name:MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Other - Org Name:DELHI MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:209-723-1920
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-7149
Mailing Address - Fax:209-726-0259
Practice Address - Street 1:9696 STEPHENS ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:CA
Practice Address - Zip Code:95315-9550
Practice Address - Country:US
Practice Address - Phone:209-667-0702
Practice Address - Fax:209-667-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP03965GMedicaid
CAZZZ61445ZOtherBLUE SHIELD GROUP
GACS1342OtherRAILROAD MEDICARE
CARHM03965GMedicaid
CAHAP03965GMedicaid
TN053965AMedicare Oscar/Certification