Provider Demographics
NPI:1932261864
Name:MOSAIC IPA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MOSAIC IPA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:559-735-3892
Mailing Address - Street 1:3335 S FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7781
Mailing Address - Country:US
Mailing Address - Phone:559-735-3892
Mailing Address - Fax:559-735-3894
Practice Address - Street 1:3335 S FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7781
Practice Address - Country:US
Practice Address - Phone:559-735-3892
Practice Address - Fax:559-735-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization