Provider Demographics
NPI:1972864247
Name:DOCTORS MEDICAL CENTER FOUNDATION
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRUAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-527-3412
Mailing Address - Street 1:730 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5413
Mailing Address - Country:US
Mailing Address - Phone:209-527-3412
Mailing Address - Fax:209-527-1512
Practice Address - Street 1:730 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5413
Practice Address - Country:US
Practice Address - Phone:209-527-3412
Practice Address - Fax:209-527-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)