Provider Demographics
NPI:1942244538
Name:TRAUMA MEDICAL GROUP OF ROSEVILLE INC
Entity Type:Organization
Organization Name:TRAUMA MEDICAL GROUP OF ROSEVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-781-1382
Mailing Address - Street 1:PO BOX 2366
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-8366
Mailing Address - Country:US
Mailing Address - Phone:916-781-1382
Mailing Address - Fax:916-781-1383
Practice Address - Street 1:ONE MEDICAL PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3080
Practice Address - Country:US
Practice Address - Phone:916-781-1382
Practice Address - Fax:916-781-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00974ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER