Provider Demographics
NPI:1881654994
Name:MEDICUS, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MEDICUS, A MEDICAL CORPORATION
Other - Org Name:CATHEDRAL CITY FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-770-4600
Mailing Address - Street 1:34131 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-6812
Mailing Address - Country:US
Mailing Address - Phone:760-770-4600
Mailing Address - Fax:760-321-1625
Practice Address - Street 1:34131 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6812
Practice Address - Country:US
Practice Address - Phone:760-770-4600
Practice Address - Fax:760-321-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42621261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062120Medicaid
CAGR0062120Medicaid
CAA49043Medicare UPIN