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NPI Code Detail

MEDICARE: INDUSTRIAL MEDICAL GROUP OF SANTA MARIA VALLEY

MEDICARE: INDUSTRIAL MEDICAL GROUP OF SANTA MARIA VALLEY
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
1261QX0100XOccupational Medicine Clinic/CenterG50357CA

General Provider Information

NPI Number : 1235383225
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDUSTRIAL MEDICAL GROUP OF SANTA MARIA VALLEY
Provider Business Mailing Address
First Line : 3070 SKYWAY DR STE 106
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-1830
Country : US
Telephone Number : 805-922-8282
Fax Number : 805-925-2690
Provider Business Practice Location Address
First Line : 3070 SKYWAY DR STE 106
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-1830
Country : US
Telephone Number : 805-922-8282
Fax Number : 805-925-2690
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. SIMON BOUGHEY
Credential : M.D.
Telephone Number : 805-922-8282
Provider Enumeration Date : 11/04/2008
Last Update Date : 11/04/2008

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Directions to “INDUSTRIAL MEDICAL GROUP OF SANTA MARIA VALLEY ” Practice Location

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