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General NPI Number Information
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NPI Number | 1669505160
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Entity Type | Organization
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Legal Business Name | STANISLAUS ORTHOPAEDIC AND SPORTS MEDICINE CLINIC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 609 E ORANGEBURG AVE
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City | MODESTO
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State | CA
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Zip | 95350-5580
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Country | US
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Telephone | 209-572-3224
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Fax | 209-572-4528
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Provider Business Mailing Address
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Address Line | 609 E ORANGEBURG AVE
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City | MODESTO
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State | CA
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Zip | 95350-5580
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Country | US
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Telephone | 209-572-3224
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Fax | 209-572-4528
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Authorized Official
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Title or Position | SENIOR PARTNER
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Name | JOHN CASEY
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Credential | M.D.
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Telephone | 209-572-3224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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