Healthcare Provider Details

I. General information

NPI: 1982645354
Provider Name (Legal Business Name): MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19901 1ST ST SUITE 4
HILMAR CA
95324-9071
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-656-8701
  • Fax: 209-656-8704
Mailing address:
  • Phone: 209-656-8701
  • Fax: 209-656-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY S. JOHNSTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-723-3704