Provider Demographics
NPI:1952707689
Name:VERNON MEDICAL GROUP INC
Entity Type:Organization
Organization Name:VERNON MEDICAL GROUP INC
Other - Org Name:VERNON URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPT MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-234-1468
Mailing Address - Street 1:231 W VERNON AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2778
Mailing Address - Country:US
Mailing Address - Phone:323-234-1468
Mailing Address - Fax:323-234-1383
Practice Address - Street 1:231 W VERNON AVE STE 112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2778
Practice Address - Country:US
Practice Address - Phone:323-234-1468
Practice Address - Fax:323-234-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty