MEDICARE: WINDSOR PRIMARY CARE MEDICAL GROUP INC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	ZZZ01370Z	OTHER	BC BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CJ5313	OTHER	RR MCR

General Provider Information

NPI Number	:	1093785826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR PRIMARY CARE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	8465 OLD REDWOOD HWY
Second Line	:	#320
City	:	WINDSOR
State	:	CA
Zip	:	95492
Country	:	US
Telephone Number	:	707-838-6685
Fax Number	:	707-838-6686

Provider Business Practice Location Address
First Line	:	8465 OLD REDWOOD HWY
Second Line	:	#320
City	:	WINDSOR
State	:	CA
Zip	:	95492
Country	:	US
Telephone Number	:	707-838-6685
Fax Number	:	707-838-6686

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA L TURNER
Credential	:	MD
Telephone Number	:	707-838-6685

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	08/22/2020

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