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General NPI Number Information
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NPI Number | 1891999108
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Entity Type | Organization
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Legal Business Name | IMPACT MEDICAL GROUP, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 5261 E KINGS CANYON RD SUITE 107
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City | FRESNO
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State | CA
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Zip | 93727-4028
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Country | US
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Telephone | 559-452-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5261 E KINGS CANYON RD SUITE 107
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City | FRESNO
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State | CA
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Zip | 93727-4028
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Country | US
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Telephone | 559-452-1000
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Fax |
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Authorized Official
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Title or Position | MD
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Name | IFEATU EKELEM
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Credential | MD
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Telephone | 559-452-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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