Healthcare Provider Details

I. General information

NPI: 1881995272
Provider Name (Legal Business Name): WESTERN SIERRA EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29100 HOSPITAL ROAD
LAKE ARROWHEAD CA
92352-9706
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 855-687-0618
  • Fax:
Mailing address:
  • Phone: 855-687-0618
  • Fax: 330-493-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN P. MARON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 855-687-0618