Provider Demographics
NPI:1932120599
Name:QUARTZ HILL WALK-IN MEDICAL GROUP
Entity Type:Organization
Organization Name:QUARTZ HILL WALK-IN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLODGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:661-943-6455
Mailing Address - Street 1:42357 50TH ST W
Mailing Address - Street 2:SUITE 107
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3529
Mailing Address - Country:US
Mailing Address - Phone:661-943-6455
Mailing Address - Fax:661-943-5775
Practice Address - Street 1:42357 50TH ST W
Practice Address - Street 2:SUITE 107
Practice Address - City:QUARTZ HILL
Practice Address - State:CA
Practice Address - Zip Code:93536-3529
Practice Address - Country:US
Practice Address - Phone:661-943-6455
Practice Address - Fax:661-943-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5697207P00000X, 207R00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE36518Medicare UPIN
CAW10799Medicare ID - Type Unspecified