Healthcare Provider Details

I. General information

NPI: 1053740845
Provider Name (Legal Business Name): REGIONAL CARDIOLOGY ASSOCIATES MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST SUITE 260
SACRAMENTO CA
95819-3628
US

IV. Provider business mailing address

1010 HURLEY WAY SUITE 500
SACRAMENTO CA
95825-3215
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-2323
  • Fax: 916-736-0620
Mailing address:
  • Phone: 916-564-3040
  • Fax: 916-564-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JAMES FOERSTER
Title or Position: PHYSICIAN/PARTNER
Credential: M.D.
Phone: 916-564-3040