Provider Demographics
NPI:1811027188
Name:PHYSICIANS MEDICAL GROUP OF SANTA CRUZ, INC
Entity type:Organization
Organization Name:PHYSICIANS MEDICAL GROUP OF SANTA CRUZ, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:831-465-7829
Mailing Address - Street 1:100 ENTERPRISE WAY STE C110
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3242
Mailing Address - Country:US
Mailing Address - Phone:831-465-7800
Mailing Address - Fax:831-464-7044
Practice Address - Street 1:100 ENTERPRISE WAY STE C110
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3242
Practice Address - Country:US
Practice Address - Phone:831-465-7800
Practice Address - Fax:831-464-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization