MEDICARE: COMMUNITY FOUNDATION MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207L00000X	Anesthesiology Physician	CA
2	207Q00000X	Family Medicine Physician
3	207R00000X	Internal Medicine Physician	CA
4	208100000X	Physical Medicine & Rehabilitation Physician
5	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
6	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134668353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY FOUNDATION MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 28949
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93729-8949
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7370 N PALM AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-5782
Country	:	US
Telephone Number	:	559-228-5400
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	SCOTT B WELLS
Credential	:
Telephone Number	:	559-228-5429

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	03/09/2023

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Directions to “COMMUNITY FOUNDATION MEDICAL GROUP ” Practice Location

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