MEDICARE: CENTRAL MEDICAL SERVICES 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	207R00000X	Internal Medicine Physician	G53709	CA

General Provider Information

NPI Number	:	1164651717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MEDICAL SERVICES INC

Provider Business Mailing Address
First Line	:	1413 W KENNETH RD # 284
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 N GATEWAY BLVD STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-1641
Country	:	US
Telephone Number	:	559-341-8762
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAM MINH LAI
Credential	:	MD
Telephone Number	:	559-341-8762

Provider Enumeration Date	:	07/03/2009
Last Update Date	:	07/03/2009

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