Provider Demographics
NPI:1821475096
Name:MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE
Other - Org Name:MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE/URGENCY MED
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BELISHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-643-9788
Mailing Address - Street 1:140 SUMMA CT
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5547
Mailing Address - Country:US
Mailing Address - Phone:831-704-3030
Mailing Address - Fax:831-657-0161
Practice Address - Street 1:140 SUMMA CT
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5547
Practice Address - Country:US
Practice Address - Phone:831-704-3030
Practice Address - Fax:831-657-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43197207XX0005X
CA20A66882081P2900X
CA20A67042081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE48487Medicare UPIN
CAG08482Medicare UPIN
CA627662Medicare UPIN