Healthcare Provider Details

I. General information

NPI: 1093895146
Provider Name (Legal Business Name): ORTHOMED CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 COFFEE RD STE 100
MODESTO CA
95355-3192
US

IV. Provider business mailing address

1335 COFFEE RD STE 100
MODESTO CA
95355-3192
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-4438
  • Fax: 209-524-1703
Mailing address:
  • Phone: 209-524-4438
  • Fax: 209-524-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL B PURNELL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 209-524-4438