Provider Demographics
NPI:1265532014
Name:LIVERMORE MEDICAL CLINIC, P.C.
Entity type:Organization
Organization Name:LIVERMORE MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-373-0337
Mailing Address - Street 1:87 FENTON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4100
Mailing Address - Country:US
Mailing Address - Phone:925-373-0337
Mailing Address - Fax:
Practice Address - Street 1:87 FENTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4100
Practice Address - Country:US
Practice Address - Phone:925-373-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ006422Medicare ID - Type Unspecified