Healthcare Provider Details

I. General information

NPI: 1538357215
Provider Name (Legal Business Name): ADVANCED KIDNEY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 COFFEE RD STE. B
BAKERSFIELD CA
93308-5024
US

IV. Provider business mailing address

PO BOX 81447
BAKERSFIELD CA
93380-1447
US

V. Phone/Fax

Practice location:
  • Phone: 661-588-9999
  • Fax: 661-588-9041
Mailing address:
  • Phone: 661-588-9999
  • Fax: 661-588-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER S MCCAULEY
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 661-588-9999