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General NPI Number Information
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NPI Number | 1235383225
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Entity Type | Organization
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Legal Business Name | INDUSTRIAL MEDICAL GROUP OF SANTA MARIA VALLEY
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 3070 SKYWAY DR STE 106
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City | SANTA MARIA
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State | CA
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Zip | 93455-1830
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Country | US
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Telephone | 805-922-8282
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Fax | 805-925-2690
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Provider Business Mailing Address
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Address Line | 3070 SKYWAY DR STE 106
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City | SANTA MARIA
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State | CA
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Zip | 93455-1830
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Country | US
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Telephone | 805-922-8282
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Fax | 805-925-2690
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SIMON BOUGHEY
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Credential | M.D.
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Telephone | 805-922-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | G50357
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License Number State | CA
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