Provider Demographics
NPI:1972657393
Name:MIDTOWN PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MIDTOWN PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-290-8672
Mailing Address - Street 1:970 RESERVE DR
Mailing Address - Street 2:SUITE 149
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1376
Mailing Address - Country:US
Mailing Address - Phone:916-290-8672
Mailing Address - Fax:
Practice Address - Street 1:970 RESERVE DR
Practice Address - Street 2:SUITE 149
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1376
Practice Address - Country:US
Practice Address - Phone:916-290-8672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G42424240Medicaid
CAA48957Medicare UPIN
CA00G424240Medicare ID - Type Unspecified