Provider Demographics
NPI:1952496697
Name:FAMILY CLINIC OF MERCED MEDICAL OFFICE INC
Entity Type:Organization
Organization Name:FAMILY CLINIC OF MERCED MEDICAL OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-383-3152
Mailing Address - Street 1:450 E YOSEMITE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8429
Mailing Address - Country:US
Mailing Address - Phone:209-383-3152
Mailing Address - Fax:209-383-3137
Practice Address - Street 1:450 E YOSEMITE AVE
Practice Address - Street 2:STE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8429
Practice Address - Country:US
Practice Address - Phone:209-383-3152
Practice Address - Fax:209-383-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26326ZMedicare PIN