Provider Demographics
NPI:1891811840
Name:PLACERVILLE INTERNAL MEDICINE INC
Entity Type:Organization
Organization Name:PLACERVILLE INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:AJUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-622-9400
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-0587
Mailing Address - Country:US
Mailing Address - Phone:530-622-9400
Mailing Address - Fax:530-622-9440
Practice Address - Street 1:1000 FOWLER WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5738
Practice Address - Country:US
Practice Address - Phone:530-622-9400
Practice Address - Fax:530-622-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty