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General NPI Number Information
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NPI Number | 1831393255
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Entity Type | Organization
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Legal Business Name | VACAVILLE URGENT CARE MEDICAL GROUP INC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 1001 NUT TREE RD STE 110
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City | VACAVILLE
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State | CA
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Zip | 95687-4166
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Country | US
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Telephone | 707-455-1343
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Fax | 707-455-7645
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Provider Business Mailing Address
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Address Line | 1001 NUT TREE RD STE 110
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City | VACAVILLE
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State | CA
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Zip | 95687-4166
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Country | US
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Telephone | 707-455-1343
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Fax | 707-455-7645
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAUTAM K VADLAMUDI
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Credential | M.D.
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Telephone | 707-455-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A51500
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License Number State | CA
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