MEDICARE: NORTHWEST PHYSICIANS MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC6650	OTHER	CA	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013983113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PHYSICIANS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	4770 W HERNDON AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-8401
Country	:	US
Telephone Number	:	559-271-6365
Fax Number	:	559-271-6326

Provider Business Practice Location Address
First Line	:	4770 W HERNDON AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-8401
Country	:	US
Telephone Number	:	559-271-6365
Fax Number	:	559-271-6326

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LISA E JELINEK
Credential	:
Telephone Number	:	559-271-6365

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	12/20/2007

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Directions to “NORTHWEST PHYSICIANS MEDICAL GROUP ” Practice Location

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