Provider Demographics
NPI:1912173121
Name:COMMUNITY MEDICAL CENTERS
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BOLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-373-2859
Mailing Address - Street 1:1600 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4409
Mailing Address - Country:US
Mailing Address - Phone:916-452-3509
Mailing Address - Fax:
Practice Address - Street 1:1600 50TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-4409
Practice Address - Country:US
Practice Address - Phone:916-452-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty