Provider Demographics
NPI:1982901070
Name:ADVENTIST HEALTH PHYSIANS NETWORK
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PHYSIANS NETWORK
Other - Org Name:HANFORD REGIONAL PHYSICIANS GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-789-4209
Mailing Address - Street 1:2100 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3804
Mailing Address - Country:US
Mailing Address - Phone:916-789-4209
Mailing Address - Fax:909-942-2675
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE #204
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-583-4695
Practice Address - Fax:559-583-4600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH PHYSIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty