Provider Demographics
NPI:1831393255
Name:VACAVILLE URGENT CARE MEDICAL GROUP INC
Entity type:Organization
Organization Name:VACAVILLE URGENT CARE MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:VADLAMUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-455-1343
Mailing Address - Street 1:1001 NUT TREE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4166
Mailing Address - Country:US
Mailing Address - Phone:707-455-1343
Mailing Address - Fax:707-455-7645
Practice Address - Street 1:1001 NUT TREE RD
Practice Address - Street 2:STE 110
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4166
Practice Address - Country:US
Practice Address - Phone:707-455-1343
Practice Address - Fax:707-455-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care