Provider Demographics
NPI:1942504360
Name:EVEREST MEDICAL GROUP INC
Entity Type:Organization
Organization Name:EVEREST MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-425-7595
Mailing Address - Street 1:3635 BRADSHAW RD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3277
Mailing Address - Country:US
Mailing Address - Phone:916-368-1500
Mailing Address - Fax:916-368-1501
Practice Address - Street 1:3635 BRADSHAW RD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3277
Practice Address - Country:US
Practice Address - Phone:916-368-1500
Practice Address - Fax:916-368-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12263011100125Medicare Oscar/Certification