Healthcare Provider Details

I. General information

NPI: 1659542561
Provider Name (Legal Business Name): CHRISTOPHER F AMSDEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 470
MODESTO CA
95350-4572
US

IV. Provider business mailing address

1524 MCHENRY AVE STE 470
MODESTO CA
95350-4572
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-8292
  • Fax: 209-525-8295
Mailing address:
  • Phone: 209-525-8292
  • Fax: 209-525-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER F. AMSDEN
Title or Position: CEO
Credential: MD
Phone: 209-525-8292