Provider Demographics
NPI:1700890043
Name:FRESNO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:FRESNO MEDICAL CENTER INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURMEJ
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-431-8900
Mailing Address - Street 1:PO BOX 25880
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5880
Mailing Address - Country:US
Mailing Address - Phone:559-431-8900
Mailing Address - Fax:559-431-4367
Practice Address - Street 1:6069 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5467
Practice Address - Country:US
Practice Address - Phone:559-431-8900
Practice Address - Fax:559-431-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAQ861Z207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ861ZOtherCMS
CAGR0089960Medicaid
CAZZZ02137ZOtherBLUE SHIELD PROVIDER ID
CAF64090Medicare UPIN
CAZZZ20843ZMedicare ID - Type UnspecifiedPROVIDER ID