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General NPI Number Information
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NPI Number | 1134543762
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Entity Type | Organization
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Legal Business Name | MADERA PHYSICIANS ASSOCIATION, INC
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 1250 E ALMOND AVE
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City | MADERA
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State | CA
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Zip | 93637-5606
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Country | US
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Telephone | 559-675-5599
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Fax | 559-675-5598
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Provider Business Mailing Address
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Address Line | 1250 E ALMOND AVE
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City | MADERA
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State | CA
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Zip | 93637-5606
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Country | US
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Telephone | 559-675-5599
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Fax | 559-675-5598
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Authorized Official
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Title or Position | IPA COORDINATOR
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Name | MS. BETTY R CATES
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Credential | N/A
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Telephone | 559-675-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | A36535
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License Number State | CA
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