MEDICARE: THE DOCTORS CENTER MEDICAL GROUP INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ13047Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1235238841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DOCTORS CENTER MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	4948 SAN JUAN AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4606
Country	:	US
Telephone Number	:	916-966-6287
Fax Number	:	916-966-2541

Provider Business Practice Location Address
First Line	:	4948 SAN JUAN AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4606
Country	:	US
Telephone Number	:	916-966-6287
Fax Number	:	916-966-2541

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD S. BLYTHE
Credential	:	M.D.
Telephone Number	:	916-966-6287

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/21/2008

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