Provider Demographics
NPI:1881991040
Name:FIRST CALL MEDICAL GROUP
Entity type:Organization
Organization Name:FIRST CALL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-357-4777
Mailing Address - Street 1:PO BOX 70528
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-0528
Mailing Address - Country:US
Mailing Address - Phone:877-357-4777
Mailing Address - Fax:951-351-4291
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:101
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3081
Practice Address - Country:US
Practice Address - Phone:877-357-4777
Practice Address - Fax:951-351-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty