Provider Demographics
NPI:1952850133
Name:INDEPENDENT PHYSICIANS OFFICE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:INDEPENDENT PHYSICIANS OFFICE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-683-6163
Mailing Address - Street 1:9045 BRUCEVILLE RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5948
Mailing Address - Country:US
Mailing Address - Phone:916-683-6163
Mailing Address - Fax:916-683-6177
Practice Address - Street 1:9045 BRUCEVILLE RD
Practice Address - Street 2:SUITE 190
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5948
Practice Address - Country:US
Practice Address - Phone:916-683-6163
Practice Address - Fax:916-683-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty