Healthcare Provider Details

I. General information

NPI: 1265257430
Provider Name (Legal Business Name): MERCED MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W OLIVE AVE
MERCED CA
95348-2400
US

IV. Provider business mailing address

650 W OLIVE AVE
MERCED CA
95348-2400
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-8047
  • Fax: 209-722-1358
Mailing address:
  • Phone: 209-722-8047
  • Fax: 209-722-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JODY KAUR
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 209-722-8047