Healthcare Provider Details

I. General information

NPI: 1255680229
Provider Name (Legal Business Name): GETTYSBURG MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 N FRESNO ST STE B
FRESNO CA
93703-3837
US

IV. Provider business mailing address

1359 N FRESNO ST STE B
FRESNO CA
93703-3837
US

V. Phone/Fax

Practice location:
  • Phone: 559-244-6362
  • Fax: 559-434-8429
Mailing address:
  • Phone: 559-244-6362
  • Fax: 559-434-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GRACE WEE LIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-244-6362