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General NPI Number Information
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NPI Number | 1891811840
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Entity Type | Organization
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Legal Business Name | PLACERVILLE INTERNAL MEDICINE INC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 1000 FOWLER WAY SUITE 6
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City | PLACERVILLE
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State | CA
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Zip | 95667-5738
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Country | US
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Telephone | 530-622-9400
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Fax | 530-622-9440
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Provider Business Mailing Address
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Address Line | PO BOX 587
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City | PLACERVILLE
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State | CA
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Zip | 95667-0587
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Country | US
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Telephone | 530-622-9400
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Fax | 530-622-9440
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KETAN P AJUDIA
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Credential | M.D.
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Telephone | 530-622-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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