Provider Demographics
NPI:1023082591
Name:TODD SPENCER MD MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:TODD SPENCER MD MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-675-9281
Mailing Address - Street 1:1100 E ALMOND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5692
Mailing Address - Country:US
Mailing Address - Phone:559-675-9281
Mailing Address - Fax:559-675-9626
Practice Address - Street 1:1250 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5606
Practice Address - Country:US
Practice Address - Phone:559-675-5436
Practice Address - Fax:559-675-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG702730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0076590Medicaid
CAGR0076590Medicaid