Healthcare Provider Details

I. General information

NPI: 1568992923
Provider Name (Legal Business Name): AMERICAN SPECIALTY PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 17TH ST STE 205
MODESTO CA
95354-1249
US

IV. Provider business mailing address

700 17TH ST STE 205
MODESTO CA
95354-1249
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7851
  • Fax: 209-248-7825
Mailing address:
  • Phone: 209-248-7851
  • Fax: 209-248-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA102350
License Number StateCA

VIII. Authorized Official

Name: MRS. TAMMY JEAN THOMPSON
Title or Position: VP FINANCE/CFO
Credential:
Phone: 209-287-6308