Provider Demographics
NPI:1245468339
Name:PACIFIC HEALTH CARE GROUP INC
Entity type:Organization
Organization Name:PACIFIC HEALTH CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-722-1111
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:691 MARAGLIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1029
Practice Address - Country:US
Practice Address - Phone:530-722-1111
Practice Address - Fax:530-722-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP39334OtherFICTITIOUS NAME PERMIT