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General NPI Number Information
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NPI Number | 1588804777
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE IPA, A MEDICAL GROUP, INC. DBA INDEPENDENCE MEDICAL GROUP
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 1801 16TH ST SUITE B
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5002
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Country | US
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Telephone | 866-814-4476
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Fax | 866-814-4478
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Provider Business Mailing Address
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Address Line | 1801 16TH ST SUITE B
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5002
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Country | US
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Telephone | 866-814-4476
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Fax | 866-814-4478
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Authorized Official
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Title or Position | NETWORK DIRECTOR
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Name | KRISTY SVENSON
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Credential |
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Telephone | 866-814-4476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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