Healthcare Provider Details

I. General information

NPI: 1952392375
Provider Name (Legal Business Name): ALTAMONT EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N TRACY BLVD EMERGENCY DEPT
TRACY CA
95376-3451
US

IV. Provider business mailing address

450 GLASS LN STE C
MODESTO CA
95356-9287
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34916
License Number StateCA

VIII. Authorized Official

Name: JANICE MARIE CRAWFORD
Title or Position: PRESIDENT
Credential: MD
Phone: 209-342-2300