Healthcare Provider Details

I. General information

NPI: 1376056721
Provider Name (Legal Business Name): COMMUNITY FOUNDATION MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 HERNDON AVE STE 105
FRESNO CA
93611-6307
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5200
  • Fax:
Mailing address:
  • Phone: 559-228-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT B WELLS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 559-228-5429