Provider Demographics
NPI:1891940987
Name:IMMEDIATE CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:IMMEDIATE CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-622-9800
Mailing Address - Street 1:231 E CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7605
Mailing Address - Country:US
Mailing Address - Phone:559-622-9800
Mailing Address - Fax:559-622-9871
Practice Address - Street 1:231 E CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7605
Practice Address - Country:US
Practice Address - Phone:559-622-9800
Practice Address - Fax:559-622-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center